Austerity Measures and Underfunding of the Spanish Health System during the COVID-19 Pandemic-Perception of Healthcare Staff in Spain.

Insufficient pandemic preparedness and underfunding of human and economic resources have conditioned the response to COVID-19 in Spain. This underfunding has continued since the austerity measures introduced during the 2008 financial crisis. This study aims to understand the perceptions of healthcare staff in Spain on the relationship between the funding of the health system and its capacity to respond to the COVID-19 pandemic. To this end, we carried out a thematic content analysis, based on 79 online semi-structured interviews with healthcare staff across the regions most affected by the COVID-19 first wave. Participants reported a lack of material resources, which had compromised the capacity of the health system before the pandemic. The lack of human resources was to be addressed by staff reorganisation, such as reinforcing hospital units to the detriment of primary health care. Staff shortages continued straining the COVID-19 response, even after material scarcities were later partially alleviated. Personnel shortages need to be adequately addressed in order to adequately respond to future health crises.

Impacto de una intervención en las consultas de Enfermería de Atención Primaria para la mejora de la calidad de la colonoscopia de cribado / Impact of an intervention in primary care nursing units for improvement in the quality of colonoscopy screening

OBJETIVO: analizar la efectividad de una intervención enfermera en Atención Primaria (AP) para la mejora de la preparación colónica de las personas que se realizan una colonoscopia de cribado. MÉTODO: estudio de evaluación antes (invitación 2015 del Programa de Cribado de Cáncer Colorrectal -PCCR-) después (invitación 2018 del PCCR) en una Unidad de Atención Primaria del País Vasco, sobre 154 personas que se hicieron la colonoscopia de confirmación tras tener resultado positivo en el PCCR. La intervención llevada a cabo por profesionales de Enfermería de AP constó de la realización de una consulta específica para instruir a los pacientes sobre la preparación colónica a través de una lista de comprobación disponible en la historia clínica digital, y una llamada recordatorio 24 horas antes de la colonoscopia. La variable principal fue la calidad de la preparación colónica (escala de Boston). Se utilizó Chi-cuadrado o el test exacto de Fisher en los análisis bivariantes. RESULTADOS: 135 personas aceptaron participar en el estudio. El 54,1% visualizó los vídeos sobre la preparación. El 94,8% recibió la llamada telefónica. La variable de resultado "calidad de la preparación de la colonoscopia" mostró diferencias estadísticamente significativas entre los dos años comparados, pudiéndose observar una preparación adecuada en más casos en el año 2018 que en el año 2015 (97,8% vs. 88,7%; p = 0,003). CONCLUSIONES: la realización de la intervención enfermera orientada a una mejor preparación colónica siguiendo la lista de comprobación estandarizado y disponible en la historia clínica, además de la llamada telefónica 24 horas antes de la colonoscopia, resultó efectiva en la mejora de la calidad de la limpieza colónica. También, ha supuesto la creación de un registro del proceso de atención de Enfermería

OBJECTIVE: to analyze the efficacy of a Primary Care (PC) nursing intervention for the colonic preparation of patients undergoing colonoscopy screening. METHOD: a before (2015 invitation by the Colorectal Cancer Screening Program - CCSP) and after (2018 invitation by the CCSP) evaluation study at a Primary Care Unit in the Basque Country, including 154 persons who underwent confirmation colonoscopy after obtaining a positive result in the CCSP. The intervention was conducted by PC Nursing professionals, and consisted of a specific training consultation for patients about colonic preparation, through a check-list available at the electronic clinical record, and a reminder call 24 hours prior to the colonoscopy. The primary variable was the quality of the colonic preparation (Boston Scale). Chi-square or Fisher's exact test were used at bivariate analyses. RESULTS: in total, 135 persons accepted to participate in the study; 54.1% of them viewed the videos on preparation, and 94.8% of them received the phone call. The "quality of the colonoscopy preparation" outcome variable showed statistically significant differences between both years compared: an adequate preparation could be observed in more cases in 2018 than in 2015 (97.8% vs. 88.7%; p = 0.003). CONCLUSIONS: conducting the nursing intervention, targeted to a better colonic preparation, and following the standard check-list available in the clinical record, as well as the phone call 24 hours prior to the colonoscopy, proved to be effective for the improvement of colonic cleansing. Moreover, it has led to the creation of a Nursing care process record