Frequency and estimated costs of ten low-value practices in the Spanish primary care: a retrospective study.

BACKGROUND: The frequency of low-value practices (LVPs) in the healthcare system is a worldwide challenge. This study aimed to evaluate the LVPs trend in Spanish primary care (PC), its frequency in both sexes, and estimate its related extra cost. METHODS: A multicentric, retrospective, and national research project was conducted. Ten LVPs highly frequent and potentially harmful for patients were analyzed (majority of them related to prescription). Algorithms were applied to collect the data from 28,872,851 episodes registered into national databases (2015-2017). RESULTS: LVPs registered a total of 7,160,952 (26.5%) episodes plus a total of 259,326 avoidable PSA screening tests. In adults, a high frequency was found for inadequate prescription of paracetamol antibiotics, and benzodiazepines . Women received more jeopardizing practices (p ≤ 0.001). Pediatrics presented a downward of antibiotic and paracetamol-ibuprofen prescription combination. The estimated extra cost was close to €292 million (2.8% of the total cost in PC). CONCLUSION: LVPs reduction during the analyzed period was moderate compared to studies following 'Choosing Wisely list' of LVPs and must improve to reduce patient risk and the extra related costs.

Proposals for person-centred care in the COVID-19 era. Delphi study.

BACKGROUND: In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies. OBJECTIVE: To identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care. DESIGN: Three-phase online qualitative study performed during May-July of 2020 using the Delphi technique. SETTING AND PARTICIPANTS: An online platform was used for a consensus meeting of 114 participants, including health planning experts, health-care institution managers, clinicians and patients. MAIN OUTCOME MEASURES: Criteria and indicators for the achievement of person-centred care. MAIN RESULTS: The first round began with 125 proposals and 11 dimensions. After the second round, 28 ideas reached a high level of consensus among the participants. Ultimately, the workgroup agreed on 20 criteria for goals in the implementation of person-centred care during the COVID-19 era and 21 related indicators to measure goal achievement. DISCUSSION: Nine dimensions and 28 priorities were identified. These priorities are also in accordance with the quadruple aim approach, which emphasizes the need for care for health-care professionals, without whom it is impossible to achieve a better quality of care. CONCLUSIONS: Person-centred care continues to be a key objective. However, new metrics are needed to ensure its continued development during the restoration of public health services beyond the control of COVID-19. PATIENT OR PUBLIC CONTRIBUTION: Twelve professionals and patient representatives participated voluntarily in the construction of the baseline questionnaire and in the selection of the criteria and indicators using an online platform for consensus meetings.

Expert consensus for primary management of reproductive health: a Delphi study.

BACKGROUND: The main barrier for an appropriate primary management of the reproductive health was lack of knowledge about the risk factors and prevention measures for infertility and the main recommendations was to involve primary care physicians in reproductive health. AIMS: To reach a consensus around barriers and enablers for appropriate primary management of the reproductive health. METHODS: An observational study was performed using the modified Delphi technique, from October 2017 to April 2018 in private and public assisted reproduction clinics in Spain. A questionnaire consisted of 58 items, divided into four blocks to explore consensus among a group of experts by synthesizing opinions. RESULTS: In the first Delphi round, the response rate was 50% and panelists reached a 72.4% of consensus. In second round, the response rate was 55% and panelists reached a 25% of consensus. To minimize limitations related to the use of a structured questionnaire, a space for free text responses was provided. The following items yielded unanimous agreement: "It is necessary to promote reproductive planning-not just contraception-from secondary school," "The media should not trivialize pregnancies in women aged over 50," "Postponing family formation is the main cause of the increase in assisted reproduction treatments in Spain," and "Postponing motherhood implies an inherently decreased probability of having children." CONCLUSIONS: These recommendations could set the basis for a public health action plan for primary management of reproductive health. The findings may be applicable to any country whose health services system provides primary healthcare.

Improving Engagement Among Patients With Chronic Cardiometabolic Conditions Using mHealth: Critical Review of Reviews.

BACKGROUND: The burden imposed by cardiometabolic diseases remains a principal health care system concern. Integration of mobile health (mHealth) interventions is helpful for telemonitoring of these patients, which enables patients to be more active and take part in their treatment, while being more conscious and gaining more control over the outcomes. However, little is known about the degree to which users engage, and the extent to which this interaction matches the usage pattern for which mHealth interventions were designed. OBJECTIVE: The aim of this study was to describe the characteristics and results of studies on mHealth solutions that measured the effects of interventions with patient engagement in the context of chronic cardiometabolic diseases. METHODS: A critical review of systematic reviews was conducted to recover data on interventions focused on the engagement of patients with chronic cardiometabolic diseases using mHealth technologies. Articles (from January 1, 2010) were searched in the Medlars Online International Literature Medline (Medline/Pubmed), Embase, Cochrane Library, PsycINFO, and Scielo databases. Only studies that quantified a measure of engagement by patients with cardiometabolic disease were included for analysis. The Critical Appraisal Skills Programme (CASP) was used to determine included studies considering the quality of the data provided. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was used to assess the quality of the evidence according to the methodology used in the studies reviewed. Engagement was defined as the level of patient implication or participation in self-care interventions. Engagement measures included number of logs to the website or platform, frequency of usage, number of messages exchanged, and number of tasks completed. RESULTS: Initially, 638 papers were retrieved after applying the inclusion and exclusion criteria. Finally, only three systematic reviews measuring engagement were included in the analysis. No reviews applying a meta-analysis approach were found. The three review articles described the results of 10 clinical trials and feasibility studies that quantified engagement and met the inclusion criteria assessed through CASP. The sample size varied between 6 and 270 individuals, who were predominantly men. Cardiac disease was the principal target in the comparison of traditional and mHealth interventions for engagement improvement. The level of patient engagement with mHealth technologies varied between 50% and 97%, and technologies incorporating smartphones with a reminder function resulted in the highest level of engagement. CONCLUSIONS: mHealth interventions are an effective solution for improving engagement of patients with chronic cardiometabolic diseases. However, there is a need for advanced analysis and higher-quality studies focused on long-term engagement with specific interventions. The use of smartphones with a single app that includes a reminder function appears to result in better improvement in active participation, leading to higher engagement among patients with cardiometabolic diseases.

[Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review].

UNLABELLED: Introducción: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in Fast-Track protocols for colorectal cancer surgery and assess morbidity-mortality and patient´s recovery. METHOD: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: "Colorectal Surgery", "Fast-Track", "Perioperative Care", "Nutrition Therapy" and "Enhanced recovery programme". Filters: "Humans", Adult (19+ years) and "Clinical Trial". Variables POSTOP outcomes: bowel recovery (BR), hospital stay (HS), complications and death. RESULTS: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by Body Mass Index while one by Subjective Global Assessment. One presented POSTOP data. Fast-Track groups had solids, liquids or supplements (SS) in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. CONCLUSIONS: Fast-Track groups had early BR (p < 0.01). Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient's recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact.

Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review / Efectos de la intervención nutricional en los programas fast-track en cirugía de cáncer colorrectal: revisión sistemática

Background and aim: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in fast-track protocols for colorectal cancer surgery and assess morbidity-mortality and patient´s recovery. Method: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: ‘colorectal surgery’, ‘fast-track’, ‘perioperative care’, ‘nutrition therapy’ and ‘enhanced recovery programme’. Filters: ‘humans’, adult (19+ years) and ‘clinical trial’. Variables POSTOP outcomes: bowel recovery (BR), hospital stay (HS), complications and death. Results: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by body mass index while one by subjective global assessment. One presented POSTOP data. Fast-track groups had solids, liquids or supplements (SS) in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. Conclusions: Fast-track groups had early BR (p < 0.01). Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient’s recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact (AU)

Introducción y objetivo: el estado nutricional (NS) preoperatorio tiene consecuencias sobre la recuperación postoperatoria (POSTOP). El objetivo fue revisar sistemáticamente las intervenciones nutricionales (NI) en los protocolos de fast-track en la cirugía de cáncer colorrectal y evaluar la morbilidad-mortalidad y la recuperación del paciente. Método: revisión sistemática de la literatura científica previa consulta a las bases de datos bibliográficas: Medline, Cochrane Library, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Descriptores MeSH: ‘colorectal surgery’, ‘fast-track’, ‘perioperative care’, ‘nutrition therapy’ and ‘enhanced recovery programme’. Filtros: ‘humans’, ‘adult (19+ years)’ and ‘clinical trial’. Variables resultados después de la operación: recuperación del intestino (BR), estancia hospitalaria (HS), complicaciones y la muerte. Resultados: los 27 estudios seleccionados tenían buena o excelente calidad metodológica. Incluían desde 25 a 597 pacientes, con edades comprendidas entre 16-94 años; los hombres fueron predominantes en el 66,6%. El estado nutricional se evaluó en 13 estudios; 7 por el índice de masa corporal, mientras que uno lo fue por la evaluación subjetiva general. Uno de ellos presentó datos después de la operación. Los grupos fast-track ingirieron, líquidos o suplementos (SS) en 2-8 horas antes. SS contenían altas cantidades de hidratos de carbono, inmunonutrientes y sin-residuos. En POSTOP se administraron líquidos, sólidos y SS. Los grupos tradicionales estuvieron en ayunas entre 3-12 horas y se reanudó la ingesta de alimentos progresivamente. Conclusiones: los grupos fast-track presentaron BR temprana (p < 0,01), los tradicionales tuvieron más infecciones, muertes y un HS más larga. Se observó gran variabilidad en las NI, pero había un punto común: ingesta temprana. A pesar de que se observó una recuperación del paciente, se necesitan futuros estudios con características de la NI más detalladas. Se debe evaluar el NS para poder reconocer el estado nutricional para un mayor reconocimiento del impacto NI (AU)

The social determinants of health of the child-adolescent immigration and its influence on the nutritional status: systematic review.

OBJECTIVE: to review the social determinants of health more characteristic of the child and adolescents of immigrants, by reviewing the literature and assess its effect on nutritional status. METHODS: a systematic review was performed using Medical Subject Headings (MeSH) in PubMed (Medline) and The Cochrane Library, in order to identify undetected studies; articles bibliographic lists were examined. The final election was done according to inclusion and exclusion criteria. No restrictions on sex and ethnicity of the participants. STROBE checkpoints were used for an information and methodological quality control. As Social Determinants of Health (SDH); social, demographic and economic conditions were considered for the study of their effect on the nutritional status. RESULTS: from 31 identified articles 18 are included in this study, 17 (94.4%) had a good or excellent quality. Hispanic and African were the most studied ethnicities; birth place and parent's residence period were used for generational classification. Alimentary culture and linguistic isolation of the first generation have a protective effect preventing from overweight and obesity risk while it decrease in second and third generation due to the experienced acculturation process equalizing their weight gain to natives; which prevalence is higher among Hispanics. No relation was found for nutritional status differences between sexes neither alimentary aids protective effect hypothesis was confirmed. CONCLUSIONS: the SDH with greater influence on child-adolescent immigrants were the socio-demographic conditions; among them: residence period distinguish the three identified generations while linguistic barrier and ethnic background are truly influential on the biological response to the experimented change caused by the acculturation process, establishing differences in the nutritional status.

Objetivo: revisar los determinantes sociales de la salud (DSS) mas caracteristicos de la poblacion infantil y juvenil de inmigrantes, mediante revision de la literatura cientifica y evaluar su efecto sobre el estado nutricional. Métodos: Se realizo una revision sistematica utilizando los Medical Subject Headings (MeSH) en PubMed (Medline) y The Cochrane Library, con el fin de identificar los estudios no detectados; se examinaron las listas de articulos bibliograficos. La eleccion final se hizo de acuerdo con los criterios de inclusion y exclusion. No hubo restricciones sobre el sexo y el origen etnico de los participantes. Se utilizaron los puntos de verificacion de la guia STROBE para un control de la informacion y la calidad metodologica. Como Determinantes Sociales de la Salud (DSS); se consideraron las condiciones sociales, demograficas y economicas para el estudio de su efecto sobre el estado nutricional. Resultados: Fueron identificados 31 articulos de los que se incluyo un total de 18 estudios, 17 (94,4%) tuvieron una buena o excelente calidad. Las etnias mas estudiadas fueron la Hispana y afroamericana; para la clasificacion generacional se utilizaron el lugar de nacimiento y tiempo de residencia de los padres. La cultura alimentaria y el aislamiento linguistico de la primera generacion tienen un efecto protector en la prevencion de riesgo de sobrepeso y obesidad, mientras que disminuye en la segunda y tercera generacion debido al proceso de aculturacion experimentado igualando su aumento de peso a los nativos; la prevalencia mas alta fue entre los hispanos. No se encontro relacion sobre las diferencias del estado nutricional entre los sexos ni se confirmo la hipotesis del efecto protector de las ayudas alimentarias. Conclusiones: los DSS con mayor influencia sobre la poblacion joven inmigrante son las condiciones socio-demograficas; entre ellos: el tiempo de residencia distingue las tres generaciones identificadas mientras que la barrera linguistica y el origen etnico son los verdaderamente influyentes en la respuesta biologica al cambio experimentado causado por el proceso de aculturacion, estableciendo asi diferencias en el estado nutricional.

The social determinants of health of the child-adolescent immigration and its influence on the nutritional status: systematic review / Los determinantes sociales de la inmigración infanto-juvenil y su influencia sobre el estado nutricional: revisión sistemática

Objective: to review the social determinants of health more characteristic of the child and adolescents of immigrants, by reviewing the literature and assess its effect on nutritional status. Methods: a systematic review was performed using Medical Subject Headings (MeSH) in PubMed (Medline) and The Cochrane Library, in order to identify undetected studies; articles bibliographic lists were examined. The final election was done according to inclusion and exclusion criteria. No restrictions on sex and ethnicity of the participants. STROBE checkpoints were used for an information and methodological quality control. As Social Determinants of Health (SDH); social, demographic and economic conditions were considered for the study of their effect on the nutritional status. Results: from 31 identified articles 18 are included in this study, 17(94,4%) had a good or excellent quality. Hispanic and African were the most studied ethnicities; birth place and parent’s residence period were used for generational classification. Alimentary culture and linguistic isolation of the first generation have a protective effect preventing from overweight and obesity risk while it decrease in second and third generation due to the experienced acculturation process equalizing their weight gain to natives; which prevalence is higher among Hispanics. No relation was found for nutritional status differences between sexes neither alimentary aids protective effect hypothesis was confirmed. Conclusions: the SDH with greater influence on child-adolescent immigrants were the socio-demographic conditions; among them: residence period distinguish the three identified generations while linguistic barrier and ethnic background are truly influential on the biological response to the experimented change caused by the acculturation process, establishing differences in the nutritional status (AU)

Objetivo: revisar los determinantes sociales de la salud (DSS) más característicos de la población infantil y juvenil de inmigrantes, mediante revisión de la literatura científica y evaluar su efecto sobre el estado nutricional. Métodos: Se realizó una revisión sistemática utilizando los Medical Subject Headings (MeSH) en PubMed (Medline) y The Cochrane Library, con el fin de identificar los estudios no detectados; se examinaron las listas de artículos bibliográficos. La elección final se hizo de acuerdo con los criterios de inclusión y exclusión. No hubo restricciones sobre el sexo y el origen étnico de los participantes. Se utilizaron los puntos de verificación de la guía STROBE para un control de la información y la calidad metodológica. Como Determinantes Sociales de la Salud (DSS); se consideraron las condiciones sociales, demográficas y económicas para el estudio de su efecto sobre el estado nutricional. Resultados: Fueron identificados 31 artículos de los que se incluyó un total de 18 estudios, 17 (94,4%) tuvieron una buena o excelente calidad. Las etnias más estudiadas fueron la Hispana y afroamericana; para la clasificación generacional se utilizaron el lugar de nacimiento y tiempo de residencia de los padres. La cultura alimentaria y el aislamiento lingüístico de la primera generación tienen un efecto protector en la prevención de riesgo de sobrepeso y obesidad, mientras que disminuye en la segunda y tercera generación debido al proceso de aculturación experimentado igualando su aumento de peso a los nativos; la prevalencia más alta fue entre los hispanos. No se encontró relación sobre las diferencias del estado nutricional entre los sexos ni se confirmó la hipótesis del efecto protector de las ayudas alimentarias. Conclusiones: los DSS con mayor influencia sobre la población joven inmigrante son las condiciones socio-demográficas; entre ellos: el tiempo de residencia distingue las tres generaciones identificadas mientras que la barrera lingüística y el origen étnico son los verdaderamente influyentes en la respuesta biológica al cambio experimentado causado por el proceso de aculturación, estableciendo así diferencias en el estado nutricional (AU)