Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study.

BACKGROUND: The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. METHODS: A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. RESULTS: The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. CONCLUSIONS: The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs.

Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study.

BACKGROUND:  Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease. OBJECTIVE:  This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics. METHODS:  A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record. RESULTS:  After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26). CONCLUSIONS:  The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.

[Perceptions and external factors of physical activity in adolescents using mixed methods]. / Percepciones y factores externos de la actividad física en adolescentes mediante métodos mixtos.

OBJECTIVE: Analyze the levels of physical activity in adolescents and their relationship with perceptions of physical activity and external factors. METHOD: Cross-sectional descriptive observational study. The participants were adolescents between the ages of 11 and 18. They were recruited in secondary schools in the municipality of Esplugues de Llobregat, Barcelona, Spain. The measurements were amount of physical activity (IPAQ-A questionnaire) and the relationship between level of physical activity and the perceptions of physical activity and external factors proposed by the health promotion model. RESULTS: Of the total sample, 60.34% participants were insufficiently active. The factors positively associated with physical activity were male gender (p<0.01), engaging in extracurricular sports (p<0.01), perceiving benefits (p<0.01), perceiving self-efficacy (p<0.01), interpersonal influences (p<0.01), having parents who engage in sports (p<0.01), social support (p<0.01) and social norms supporting exercise (p<0.01). The factors negatively associated with physical activity were female gender (p<0.01), body mass index (p=0.048) and perceiving obstacles (p<0.01). There was no relationship with social class (p=0.164). Situational influences were a conditioning factor for boys (p<0.01), but not girls (p=0.561). CONCLUSIONS: This study identifies factors that determinate the practice of physical activity in adolescents. Taking these factors into account in the design of health promotion interventions and policies could help increase levels of physical activity in this population. Even so, there are some variables, such as gender and socioeconomic status, that should be explored in depth through research that is more exploratory and discursive.

[Promotion of physical activity]. / Promoción de la actividad física.

AIM: To know the influence of the factors that determine physical exercise in adults and elderly by the analysis of the determinants categories of health-promoting behaviors in the health promotion nursing model (MPS) of Pender. METHODOLOGY: A descriptive review of the literature was conducted in order to identify the influencing factors in the adoption and maintenance of physical exercise as a health promotes behavior. The databases consulted were PubMed-MEDLINE via RefWorks bibliography manager, CUIDEN and CUIDATGE. The search was conducted in 2010 and 2011, including publications in English and Spanish. RESULTS: 18 articles were reviewed to assess the influence, in adult and elderly population, of the factors: prior related behavior; personal factors; perceived benefits of action; perceived barriers to action; perceived self-efficacy; activity-related affect; interpersonal influences; situational influences; immediate competing demands and preferences; commitment to a plan of action. DEVELOPMENT AND DISCUSSION: Many studies have demonstrated the validity and predictive ability of the model studied in this article (MPS). There are complex biopsychosocial processes that motivate individuals to engage in behaviors to promote health. The MPS variables and their relationship are relevant in the decision to adopt increased physical activity behaviors. CONCLUSIONS: The Health Promotion Model facilitates the evaluation of the elements that influence behavior and helps nurses to identify how willing a person to exercise, what are their difficulties and can decide what interventions are most seek to promote physical activity.