[Assessment of a chronic care program in Gerona (CRONIGICAT)]. / Evaluación de un programa de atención a la cronicidad en Girona (CRONIGICAT).

OBJECTIVE: To determine the utility and viability of a chronic care program. DESIGN: Cross-sectional descriptive study with qualitative and quantitative evaluation. SETTING AND PARTICIPANTS: 26 primary care teams (PCT) from the Catalan health service of Gerona. INTERVENTIONS: 20 projects within the program. Start 2011. MAIN OUTCOME MEASURES: The degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]). RESULTS: Evaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. CONCLUSIONS: When assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.

Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data.

BACKGROUND: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. OBJECTIVE: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. METHODS: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. RESULTS: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. CONCLUSIONS: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.

[Self-audit and tutor accreditation]. / Self-audit y la acreditación de tutores.

OBJECTIVE: To describe the experience of using self-audit (SA) as a means of accrediting family and community medicine tutors, to analyse the knowledge that the tutors have on this self-assessment methodology, and to record their opinions on this method. DESIGN: Retrospective descriptive study and analysis of an opinion questionnaire. SETTING: Family and community medicine teaching units (TU) in Catalonia. PARTICIPANTS: Tutors from family and community medicine TU in Catalonia (July 2001-July 2008). METHODS: Training of the tutors in SA methodology, creation of a reference group and a correction cycle. Correction by peers of the SAs performed by the tutors according to previously determined criteria and subsequent issue of a report-feedback. Self-administered questionnaire by a group of TU tutors. MEASUREMENTS AND MAIN OUTCOMES: A total of 673 SA were performed. The most frequent topic selected was diabetes mellitus in 27.9% of cases. The overall evaluation of the SA from a methodological point of view was correct in 44.5% of cases, improvable in 45.3%, and deficient in 10.2%. A total of 300 opinion questionnaires were issued. The response rate was 151/300 (50.03%). On the question about the usefulness of the SA in professional practice, 12% considered it very useful, 56% adequate, and 32% of little use or not useful. As regards whether it was a good means for the re-accreditation or accreditation of tutors, 66% considered that it was not. CONCLUSIONS: A high percentage of the SAs analysed are not carried out correctly, which indicates that tutors do not know this self-assessment method very well. They consider that SAs are a useful tool for improving clinical practice, but not a good means for accreditation and re-accreditation.

[Final results of a multifactorial and community intervention study for the prevention of falls in the elderly]. / Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos.

OBJECTIVE: To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the >or=70 years population in a community. DESIGN: Multicentre, community intervention study, with no random assignment and with controls. SETTING: Two basic health areas in the province of Girona (Spain). PARTICIPANTS: Random sample of people >or=70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. MEASUREMENTS AND PRIMARY OUTCOMES: The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. RESULTS: (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8-31.9) and post-intervention 31% (95% CI: 25.6-36.5). CG baseline 32% (95% CI: 28.8-35.2) and post-intervention 30% (95% CI: 24.9-35.4). Falls with fractures: IG baseline 10.4% (95% CI:6-16.3) and post-intervention 5.3% (95% CI:2-11,2); CG baseline 7% (95% CI:4-11.2) and post-intervention 10.7% (95% CI:5.8-17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37-54) and post-intervention 43.8% (95% CI: 34.4-54.4). GC baseline 30.3% (95% CI: 24.3-36.8) and post-intervention 40.8% (95% CI: 31-51.2). CONCLUSIONS: A multifactorial community intervention programme in people >or=70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

Evaluación de un programa de atención a la cronicidad en Girona (CRONIGICAT) / Assessment of a chronic care program in Gerona (CRONIGICAT)

OBJETIVO: Determinar la utilidad y viabilidad del Programa CRONIGICAT. DISEÑO: Estudio descriptivo transversal. Método de evaluación cualitativo y cuantitativo. Emplazamiento y participantes: 26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona. Intervenciones: 20 proyectos dentro del programa. Inicio 2011. Mediciones principales: Grado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad). RESULTADOS: Valoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48 h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado. CONCLUSIONES: Respecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual

OBJETIVO: Determinar la utilidad y viabilidad del Programa CRONIGICAT. DISEÑO: Estudio descriptivo transversal. Método de evaluación cualitativo y cuantitativo. Emplazamiento y participantes: 26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona. Intervenciones: 20 proyectos dentro del programa. Inicio 2011. Mediciones principales: Grado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad). RESULTADOS: Valoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48 h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado. CONCLUSIONES: Respecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual

Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos / Final results of a multifactorial and community intervention study for the prevention of falls in the elderly

Objetivo Evaluar la efectividad de un programa de intervención multifactorial y comunitario para disminuir el número de caídas y sus complicaciones en la población de 70 años o más de una comunidad. Diseño Estudio de intervención comunitaria, multicéntrico, con grupo control y sin asignación aleatorizada. Emplazamiento Dos zonas básicas de salud de la provincia de Girona (España). Participantes Muestra aleatorizada de personas 70 años o más, 2.515 en el grupo de intervención (GI) y 1.212 en el grupo control (GC). Participantes El GI recibió una intervención multifactorial con actividades comunitarias, individuales en la consulta o domicilio y sobre los profesionales durante 2 años. El GC recibió la atención sanitaria habitual. Mediciones y resultados principales Se valoró la situación basal de 2 muestras aleatorizadas representativas, GI (n=329) y GC (n=379), y la situación posintervención del GI (n=292) y el GC (n=310) mediante una encuesta. Personas con caídas GI basal, el 29% (intervalo de confianza [IC] del 95%: 25,8–31,9) y posintervención, el 31% (IC del 95%: 25,6–36,5); GC basal, el 32% (IC del 95%: 28,8–35,2) y posintervención, el 30% (IC del 95%: 24,9–35,4). Caídas con fracturas: GI basal, el 10,4% (IC del 95%: 6–16,3) y posintervención, el 5,3% (IC del 95%: 2–11,2); GC basal, el 7% (IC del 95%: 4–11,2) y posintervención, el 10,7% (IC del 95%: 5,8–17,7). Caídas con asistencia médica: GI basal, el 45,4% (IC del 95%: 37–54) y posintervención, el 43,8% (IC del 95%: 34,4–54,4); GC basal, el 30,3% (IC del 95%: 24,3–36,8) y posintervención, el 40,8% (IC del 95%: 31–51,2). Conclusiones n programa de intervención comunitario multifactorial en personas de 70 años o más no reduce el número de caídas a los 2 años, pero se observa una tendencia a la reducción de sus consecuencias y puede integrarse dentro de la actividad asistencial habitual (AU)

Objective To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the >=70 years population in a community. Design Multicentre, community intervention study, with no random assignment and with controls. Setting Two basic health areas in the province of Girona (Spain). Participants Random sample of people >=70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). Participants The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. Measurements and primary outcomes The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. Results (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2). Conclusions A multifactorial community intervention programme in people >=70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities(AU)

Self-audit y la acreditación de tutores / Self-audit and tutor accreditation

ObjetivoDescribir la experiencia de utilización del self audit (SA) como criterio de acreditación de los tutores de medicina familiar y comunitaria, analizar el conocimiento que tienen los tutores de esta metodología de autoevaluación y recoger su opinión respecto a este método.DiseñoEstudio descriptivo retrospectivo y análisis de un cuestionario de opinión.EmplazamientoUnidades docentes (UU.DD.) de medicina familiar y comunitaria de Cataluña.ParticipantesTutores de las UU.DD. de medicina familiar y comunitaria de Cataluña (julio de 2001 a julio de 2008).IntervencionesFormación de los tutores en la metodología SA, creación de un grupo de referencia y circuito de corrección. Corrección por pares de los SA realizados por los tutores según unos criterios determinados previamente y envío posterior de un informe-feedback. Encuesta de opinión autoadministrada a un grupo de tutores de las UU.DD.Mediciones y resultados principalesSe realizaron 673 SA. El tema más frecuentemente escogido fue la diabetes mellitus (27,9% de los casos). La valoración global de los SA desde un punto de vista metodológico fue correcta en el 44,5% de los casos, mejorable en el 45,3% y deficiente en el 10,2%.Mediciones y resultados principalesEn relación con los cuestionarios de opinión, se enviaron 300. El índice de respuesta fue de 151/300 (50,3%). Ante la pregunta sobre la utilidad del SA para la práctica profesional, un 12% lo consideraba muy útil; un 56%, bastante útil y un 32%, poco o nada útil.Mediciones y resultados principalesRespecto de si era un buen criterio para la reacreditación y acreditación de tutores, un 63% opinaba que no...(AU)

ObjectiveTo describe the experience of using self-audit (SA) as a means of accrediting family and community medicine tutors, to analyse the knowledge that the tutors have on this self-assessment methodology, and to record their opinions on this method.DesignRetrospective descriptive study and analysis of an opinion questionnaire.SettingFamily and community medicine teaching units (TU) in Catalonia.ParticipantsTutors from family and community medicine TU in Catalonia (July 2001–July 2008).MethodsTraining of the tutors in SA methodology, creation of a reference group and a correction cycle. Correction by peers of the SAs performed by the tutors according to previously determined criteria and subsequent issue of a report-feedback. Self-administered questionnaire by a group of TU tutors.Measurements and main outcomesA total of 673 SA were performed. The most frequent topic selected was diabetes mellitus in 27.9% of cases. The overall evaluation of the SA from a methodological point of view was correct in 44.5% of cases, improvable in 45.3%, and deficient in 10.2%.Measurements and main outcomesA total of 300 opinion questionnaires were issued. The response rate was 151/300 (50.03%). On the question about the usefulness of the SA in professional practice, 12% considered it very useful, 56% adequate, and 32% of little use or not useful.Measurements and main outcomesAs regards whether it was a good means for the re-accreditation or accreditation of tutors, 66% considered that it was not.ConclusionsA high percentage of the SAs analysed are not carried out correctly, which indicates that tutors do not know this self-assessment method very well. They consider that SAs are a useful tool for improving clinical practice, but not a good means for accreditation and re-accreditation(AU)