Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol.

INTRODUCTION: The increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on person-centred care model. This article outlines a study protocol, which aims to explore the effects of the intervention to improve therapeutic adequacy in polymedicated elderly patients. METHODS AND ANALYSIS: An open, randomised, multicentre, controlled clinical trial. The study population includes polymedicated (≥8 prescription medications) patients ≥75 years old. In the intervention group, the multidisciplinary team (primary care pharmacist, family doctor and nurse) will meet to carry out multidimensional reviews (frailty, clinical complexity, morbidity and therapeutic adequacy) of the study subjects. If changes are proposed to the treatment plan, a clinical interview will be conducted with the patient to agree on changes in accordance with their preferences. Follow-up visits will be scheduled at 6 and 12 months. In the control group, where the usual clinical practice will be followed, the necessary data will be collected to compare the results.The key variables are the variation in the mean number of incidents (potentially inappropriate prescription) per patient, the number of medications, the number of changes implemented to the treatment plan and the variation in the number of hospital admissions. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the IDIAPJGol and by the University of Barcelona's Bioethics Commission. The results are expected to be published in peer reviewed open-access journals, and as part of a doctoral thesis. TRIAL REGISTRATION NUMBER: NCT04188470. Pre-results.

Población potencialmente excluida de cobertura sanitaria con el Real Decreto 16/2012 y sus repercusiones sanitarias: la experiencia desde la Cataluña Central / Potentially excluded population from health coverage and health impact since Royal Decree 16/2012: The Central Catalonia experience

OBJETIVO: Conocer la proporción de población potencialmente excluida de cobertura sanitaria a partir del Real Decreto-Ley 16/2012. Describir el uso de servicios sanitarios, la distribución de patología crónica e infecciosa y el gasto farmacéutico en 2012 de las personas excluidas respecto a las que mantendrían su cobertura. Diseño y emplazamiento: Estudio observacional analítico transversal de base poblacional en atención primaria. Gerencia Territorial de la Cataluña Central del Institut Català de la Salut. Participantes y MEDICIONES PRINCIPALES: Se seleccionaron las personas potencialmente excluidas a partir de la aplicación del Real Decreto-Ley 16/2012 y se compararon con las personas que mantendrían su cobertura sanitaria apareadas de forma aleatoria por edad, sexo y servicio de atención primaria. La información obtenida incluyó el uso de servicios sanitarios, la distribución de patologías crónicas e infecciosas y el gasto farmacéutico durante el año 2012. RESULTADOS: Se identificaron 1.699 personas, el 0,53% del total de la población (51,4% hombres), con una mediana de edad de 34 años (rango intercuartílico, 28-43) potencialmente excluidas de cobertura sanitaria. El uso de servicios sanitarios, la morbilidad crónica registrada y el gasto farmacéutico durante el año 2012 de los excluidos fueron inferiores a los de los no excluidos (p < 0,001). En cambio, la morbilidad infecciosa fue superior en los excluidos (p < 0,001). CONCLUSIONES: Los resultados del estudio llevan a pensar que esta medida legislativa no parece justificada por razones médicas ni económicas. Además, podría provocar problemas de salud pública y contribuir al riesgo de fractura social

OBJECTIVE: To assess the proportion of population potentially excluded from healthcare coverage since the Royal Decree-Law 16/2012. To describe the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs in 2012 of the persons potentially excluded compared to the those who maintain their coverage. Design and SETTING: An observational analytical cross-sectional study was designed and conducted on a Primary Care based population in the Central Catalonia Management Area of the Institut Català de la Salut Participants and MAIN MEASUREMENTS: Individuals potentially excluded since the application of the Royal Decree-Law 16/2012 were selected and compared with individuals who maintained their healthcare coverage, randomly matched by sex, age and Primary Care service. The information obtained included the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs during the year 2012. RESULTS: A total of 1,699 individuals were identified as potentially excluded from healthcare coverage, 0.53% of the total of population (51.4% men), with a median of age of 34 years (interquartile range, 28-43). The use of healthcare services, the chronic morbidity recorded, and the pharmaceutical costs during the year 2012 of the excluded individuals was lower than those of the non-excluded ones (P < .001). On the other hand, the infectious morbidity was higher in the excluded individuals (P < .001). CONCLUSIONS: The results of the study suggests that this legislative measure does not seem to be justified for medical or economic reasons. It could also cause public health problems and contribute to the risk of social fracture

[Potentially excluded population from health coverage and health impact since Royal Decree 16/2012: The Central Catalonia experience]. / Población potencialmente excluida de cobertura sanitaria con el Real Decreto 16/2012 y sus repercusiones sanitarias: la experiencia desde la Cataluña Central.

OBJECTIVE: To assess the proportion of population potentially excluded from healthcare coverage since the Royal Decree-Law 16/2012. To describe the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs in 2012 of the persons potentially excluded compared to the those who maintain their coverage. DESIGN AND SETTING: An observational analytical cross-sectional study was designed and conducted on a Primary Care based population in the Central Catalonia Management Area of the Institut Català de la Salut PARTICIPANTS AND MAIN MEASUREMENTS: Individuals potentially excluded since the application of the Royal Decree-Law 16/2012 were selected and compared with individuals who maintained their healthcare coverage, randomly matched by sex, age and Primary Care service. The information obtained included the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs during the year 2012. RESULTS: A total of 1,699 individuals were identified as potentially excluded from healthcare coverage, 0.53% of the total of population (51.4% men), with a median of age of 34years (interquartile range, 28-43). The use of healthcare services, the chronic morbidity recorded, and the pharmaceutical costs during the year 2012 of the excluded individuals was lower than those of the non-excluded ones (P<.001). On the other hand, the infectious morbidity was higher in the excluded individuals (P<.001). CONCLUSIONS: The results of the study suggests that this legislative measure does not seem to be justified for medical or economic reasons. It could also cause public health problems and contribute to the risk of social fracture.