Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

BACKGROUND: The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. METHODS: A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. RESULTS: The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). CONCLUSIONS: A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

Diagnósticos enfermeros estandarizados: guía para la práctica clínica en Atención Primaria / Standardised nursing diagnoses: clinical practice guidelines in Primary Care

En 1994 un grupo de enfermeras asistenciales de Atención Primaria de Salud (APS) de Barcelona iniciamos un trabajo orientado a desarrollar la especificidad de la atención enfermera adoptando el modelo de Virginia Henderson y utilizando la metodología del proceso de cuidados. Nuestro objetivo era aportar un instrumento de trabajo útil que ayudase, en todas las etapas del proceso, a salvar la distancia que separa la teoría de los modelos enfermeros de la práctica clínica y que, posteriormente, su utilización permitiera validar el contenido de los distintos diagnósticos enfermeros (DxE) elaborados. Metodología: los DxE más frecuentes en la práctica asistencial fueron seleccionados utilizando la técnica de grupo nominal. Cada uno de los diagnósticos elaborados se revisó por primera vez en el año 2000 para incorporar aportaciones de la literatura científica respecto a los objetivos, así como a las intervenciones utilizando la “Nursing Intervention Classifications (NIC)”. La segunda revisión fue en el 2005 para incorporarla codificación de los objetivos ya formulados según “Nursing Outcome Classification (NOC)”.Resultados: identificación de 36 diagnósticos enfermeros y elaboración de la guía de actuación correspondiente en cada uno de ellos. Conclusiones: las guías de cuidados estandarizados sirven como pauta de trabajo, siendo imprescindible personalizar la valoración para individualizarlos cuidados y permiten la identificación del rol autónomo de la enfermera. Su informatización ha facilitado el registro del proceso enfermero. Sería interesante recoger posibles variaciones de las guías propuestas para analizar y modificarlas si está indicado (AU)

In 1994 a group of healthcare nurses serving at Primary Care Health units in Barcelona started a project aimed at developing the specificity of nursing care by adopting the Virginia Henderson’s model and by utilising care process methodology. Our objective was to contribute with a useful working tool that helped in all the stages of the process to shorten the distance between theory and the nursing models used in clinical practice so that these could be subsequently used to validate the contents of the elaborated nursing diagnoses. Methodology: the nursing diagnoses most frequently used in healthcare practice were selected using the nominal group technique. Each of the elaborated diagnoses was revised for the first time in 2000 to include the contribution of the scientific literature regarding objectives and the interventions using the “Nursing Intervention Classifications (NIC)”. The second revision was performed in 2005 to incorporate the codification of already existing objectives according to the “Nursing Outcome Classification(NOC)”.Results: identification of 36 nursing diagnosis and elaboration of a clinical practice guideline for each of these diagnoses. Conclusions: standardised clinical care guidelines serve as a work guideline and are essential to personalise the assessment in order to individualise the care given, which also permits to identify the autonomous role of the nurse. Automation of standardised guides has facilitated the nursing process. It would be interesting to compile possible variations from the proposed guidelines for their analysis and amendment if necessary (AU)