Study protocol: assessment of the usefulness and practicability of a psychoeducational intervention to prevent the negative psychological impact of the COVID-19 pandemic on primary care health workers.

BACKGROUND: The COVID-19 pandemic has constituted an extraordinarily stressful situation for healthcare professionals and has led to psychological distress and an increase in various mental disorders. In the post-pandemic context, it is necessary to provide professionals with strategies and skills to manage this stressful situation and prevent or minimize its negative impact. METHODS: Aims: To assess the feasibility and clinical effects of a group psychoeducational program focused on preventing the adverse psychological and emotional effects of the pandemic on primary care workers, and to explore the experience and perceptions of participants with regard to the program from a qualitative perspective. DESIGN: A single-arm, before-and-after study conducted in primary care. SETTING: The 332 primary care centers of the Catalan Institute of Health (Catalonia, Spain) Participants: The target population of the intervention is primary care workers, including clinical profiles (e.g., nurses and doctors), and non-clinical profiles (e.g., administrative staff). The implementation strategy will also involve community psychologists, who will lead the psychoeducational groups, and the health organization promoting the implementation. INTERVENTION: A group psychoeducational program targeting primary care workers to promote emotional well-being and the ability to cope with stressful situations. Community psychologists will deliver it in the primary care centers they are linked to. MEASURES: Mixed-methods evaluation, combining quantitative and qualitative research. A prospective assessment of the main outcomes (professional quality of life, psychological state, and resilience) will be performed using online questionnaires before and immediately after the intervention, and at 3 and 6 months. A qualitative study will be conducted, comprising focus groups and individual in-depth interviews with the participants in the intervention and the psychologists who provide it. ETHICS: The Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP) has approved the protocol (22/086-PCV). DISCUSSION: This project proposes an intervention to promote mental health and psychological well-being in primary care workers by learning skills and integrating them into personal and professional life. The expected results will allow us to determine the usefulness and effectiveness of this psychoeducational intervention under the conditions of real clinical practice, provide data to model and perfect it, and promote its dissemination. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05720429; registered on 09/02/2023.

"Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records".

BACKGROUND: The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. METHODS: We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. RESULTS: We analysed 740,820 new chronic diseases' diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%). CONCLUSIONS: Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.

Designing a Person-Centred Integrated Care Programme for People with Complex Chronic Conditions: A Case Study from Catalonia.

INTRODUCTION: The prevalence of people with complex chronic conditions is increasing. This population's high social and health needs require person-centred integrated approaches to care. METHODS: To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients' associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals. RESULTS: Patients' and caregivers' main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. CONCLUSION: We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.