Characteristics of adults who reported not having had COVID-19 in Spain after the first two years of the pandemic and associated factors.

BACKGROUND: There is little evidence regarding the characteristics of adults who self-reported not having had COVID-19 after two years of the pandemic. This study aimed to analyse the characteristics of no-COVID-19 respondents and the associated factors to better understand which may have conditioned not having had the disease as guidance to help in the design of better public health strategies. METHODS: This cross-sectional, observational study was conducted in the Spanish general population in a representative sample of 1051 adults who completed an online survey in September 2022. Multivariable logistic regression was performed to assess which factors were related to reporting not having had COVID-19. RESULTS: Almost half of the respondents (47.8%) reported not having ever had COVID-19. Significant differences were found between people who reported having had and not having had COVID-19 according to sex, age, education level, employment and living with children. No-COVID-19 respondents had greater concern and less fear of the disease and were more worried about the new variants. After the multivariable analysis, factors associated with no-COVID-19 respondents were male sex (OR)=1.40; 95% (CI=1.07-1.82), older age (OR=1.01; 95% CI=1.01-1.03), having a greater perception of disease severity if infected (OR=4.71; 95% CI=2.97-7.47), greater adherence to preventive measures (OR=1.02; 95% CI=1.01-1.03), and having received a complete vaccination schedule and booster dose (OR=1.56; 95% CI=1.03-2.36). CONCLUSIONS: Analysing the characteristics of people reporting not having had COVID-19 can support public health decision-makers in designing better interventions and facilitating the implementation of effective prevention and control measures to prepare for and respond to a possible future pandemic.

Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid).

Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions.

Introduction: Identifying stakeholders' needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers. Methods: Cross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals. Results: A total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies. Discussion: Findings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of all.

Social determinants of visceral leishmaniasis elimination in Eastern Africa.

Visceral leishmaniasis is a vector-borne, protozoan disease with severe public health implications. Following the successful implementation of an elimination programme in South Asia, there is now a concerted endeavour to replicate these efforts in Eastern Africa based on the five essential elimination pillars of case management, integrated vector management, effective surveillance, social mobilisation and operational research. This article highlights how key social determinants (SD) of health (poverty, sociocultural factors and gender, housing and clustering, migration and the healthcare system) operate at five different levels (socioeconomic context and position, differential exposure, differential vulnerability, differential outcomes and differential consequences). These SD should be considered within the context of increasing the success of the five-pillar elimination programme and reducing inequity in health.

Trends in COVID-19 Vaccine Acceptance in Spain, September 2020‒May 2021.

Objectives. To analyze factors associated with COVID-19 vaccine acceptance in Spain, over time. Methods. We used data from a national study that included 5 online surveys carried out every 2 months from September 2020 to May 2021. Each round recruited a sample of 1000 participants aged 18 years or older. We performed a multivariable logistic regression with vaccination acceptance as the dependent variable. We evaluated time trends through the interaction terms of each of the explanatory variables and the time. Results. Vaccination acceptance increased from 43.1% in September 2020 to 84.5% in May 2021. Sex, age, concerns about disease severity, health services overload, and people not wearing a face mask, together with adherence to preventive behavior, health literacy, and confidence in scientists, health care professionals' information, and adequacy of governmental decisions, were variables associated with vaccination acceptance. Conclusions. In a changing situation, vaccine acceptance factors and time trends could help in the design of contextualized public health messages. It is important to strengthen the population's trust in institutions, health care professionals, and scientists to increase vaccination rates, as well as to ensure easy access to accurate information for those who are more reluctant. (Am J Public Health. 2022;112(11):1611-1619. https://doi.org/10.2105/AJPH.2022.307039).

Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic.

The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.

Health Problems Encountered by Short-Term European Volunteers in a Nongovernmental Organization in Cambodia.

Short-term volunteers are susceptible to a wide spectrum of morbidities, mostly infectious diseases preventable with general hygiene and preventive measures. This study aimed to identify the health problems encountered by European short-term volunteers collaborating for 1 month with a nongovernmental organization (NGO) in Cambodia and to describe their characteristics. A prospective, descriptive observational study was conducted on short-term volunteers who collaborated with an NGO in Cambodia during August 2018. Informed consent and sociodemographic, clinical, and preventative health-related questionnaire data were provided by 198 volunteers. The health problems encountered were confirmed in a primary care consultation with healthcare professionals. Univariate and bivariate analyses were performed. The median age of the volunteers was 22 years (interquartile range = 21-24), and 64% were women. Some (18.2%) had allergies, 8.6% had preexisting health conditions, and 10.6% were under regular treatment. A total of 77.3% visited a pretravel consultation clinic, 39.9% completed a specific pretravel health course, 21.7% took malaria prophylaxis, 92.4% received hepatitis A vaccination, and 82.3% received typhoid fever vaccination. Medical assistance was sought by 112 (57.3%) of the volunteers. The average number of health problems was 2.5 (standard deviation = 1.5), and the total number of health problems attended by the medical team was 279. The most common health problems were upper respiratory infections (12.2 per 1,000 person/days), wounds (10.8 per 1,000 person/days), and diarrhea (6.3 per 1,000 person/days). Short-term volunteers experienced a high rate of health problems during their stay in Cambodia, but most of the problems were mild and preventable and resolved quickly. Pretravel consultation and specific pretravel health training seemed to increase disease awareness.

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception.

In epidemics such as COVID-19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID-19-related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO-Spain survey, based on the WHO Behavioral Insights questionnaire on COVID-19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter-quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID-19 spreads and wearing masks properly; appropriate attitudes towards COVID-19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non-mask wearers), and adherence to other preventive measures against COVID-19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.

Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups.

BACKGROUND: Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors. METHODS: Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed. RESULTS: The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017-0.052 and 0.008-0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198-1.726 and 2.722-4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457-14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022-6241 and 1.949-3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068-1.51 and 0.103-0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659-4.319 and 3.629-4.989). CONCLUSIONS: The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.

Uso de hidroxicloroquina en pacientes COVID ambulatorios: evaluación de interacciones y riesgo cardiaco / Use of hydroxychloroquine in outpatient COVID-19 patients: evaluation of interactions and cardiac risk

Objetivo: La hidroxicloroquina fue ampliamente utilizada al inicio de la pandemia de COVID-19 fuera de ficha técnica y con poca evidencia de eficacia. El objetivo de nuestro trabajo fue identificar inte-racciones entre hidroxicloroquina y otros fármacos con riesgo conocido de prolongar el intervalo QT, así como factores de riesgo asociados con el inicio de Torsade de Pointes, en pacientes no hospitaliza-dos diagnosticados de COVID-19.Método: La población de estudio fueron pacientes procedentes de dos áreas de salud. Se consideró toda la medicación que tuvieran prescrita. Las interacciones se analizaron con la herramienta Medsafety Scan®. Se realizó encuesta al médico de referencia. El análisis estadístico se realizó con el programa IBM® SPSS® statistics version 20.Resultados: El número medio de fármacos con capacidad de prolongar el intervalo QT por pa-ciente, incluyendo la hidroxicloroquina fue de 2,8. Se encontraron interacciones en el 93,2% de los pacientes. La mayoría de los pacientes estaban afectados por al menos 2 interacciones, aunque en pacientes institucionalizados un alto porcenta-je tenía hasta 4. La interacción más repetida fue hidroxicloroquina-antibióticos (en 85% de ellos), fundamentalmente debido al uso de azitromicina con hidroxicloroquina, hidroxicloroquina-antiácidos (38%) y hidroxicloroquina-antidepresivos (23%). La encuesta muestra que 15,3% de los pacientes tuvie-ron algún efecto adverso asociado con la hidroxi-cloroquina.Conclusiones: Los pacientes no hospitalizados fue-ron expuestos a un alto porcentaje de interacciones entre hidroxicloroquina y otros fármacos con la capacidad de prolongar el intervalo QT. Ante una eficacia no claramente demostrada para la hidroxi-cloroquina, los pacientes estuvieron expuestos a un posible riesgo innecesario.(AU)

Purpose: Hydroxychloroquine was widely used at the beginning of the COVID-19 pandemic with little evidence and off-label use. The objective of our work was to identify in non-hospitalized patients diagnosed with COVID-19 interactions of hydroxy-chloroquine and other drugs with known risk of prolonging the QT interval, as well as risk factors associated with the onset of Torsade de Pointes.Methods: The studied population included pa-tients at home and in nursing homes centers in two health areas. All medications prescribed were considered. The MedSafety Scan® tool was used to analyze interactions. A survey was conducted to all the doctors. Statistical analysis was performed with the IBM® SPSS® statistics version 20 program.Results: The average number of drugs with the capacity to prolong the QT interval in each patient including hydroxychloroquine was 2.8. We found interactions in 93.2% of the patients. Most were affected by, at least, 2 interactions although in insti-tutionalized patients a high percentage had up to 4. The most repeated was hydroxycholoroquine-an-tibiotics interaction (in 85% of them) mainly due to use of azithromycin with hydroxychloroquine, hy-droxychloroquine–antiacids (38%) and hydroxychlo-roquine-antidepressants (23%). The survey shows that 15.3% of the patients had some adverse effect associated with hydroxychloroquine.Conclusions: Non-hospitalized patients were ex-posed to a high percentage of interactions between hydroxychloroquine and other drugs with the ability to prolong the QT interval. Faced with a possible efficacy not clearly demonstrated for hydroxy-chloroquine, patients were exposed to a possible unnecessary risk.(AU)

Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level.

BACKGROUND: Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services. METHODS: This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done. RESULTS: A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76-85 years old, it was 22.1 (SD = 20.3); and in people 66-75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2-0.4), high risk level (BC = 1.9; 95%CI =0.4-3.2), weight of complexity (BC = 0.7; 95%CI = 0.5-0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3-1.1). CONCLUSIONS: In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

Enfermedades crónicas en población pediátrica: comorbilidades y uso de servicios en atención primaria / Chronic diseases in the paediatric population: Comorbidities and use of primary care services

INTRODUCCIÓN: Los grupos de morbilidad ajustados (GMA) están siendo utilizados en la estratificación de los pacientes crónicos en atención primaria (AP). El objetivo del estudio fue describir las características, prevalencia de comorbilidades y utilización de servicios en AP de los pacientes crónicos pediátricos y analizar factores asociados al peso de complejidad según GMA. PACIENTES Y MÉTODOS: Estudio observacional descriptivo transversal. Se incluyeron los pacientes<18 años de una zona básica de salud clasificados como crónicos según los GMA de la historia clínica electrónica de AP de la Comunidad de Madrid. Se recogieron variables sociodemográficas, clínico-asistenciales y de uso de servicios en AP. Análisis univariado, bivariado y regresión lineal. RESULTADOS: De los 2.961 pacientes<18 años se identificaron como crónicos 423 (15,7%), de los que 408 (96,5%) eran de bajo riesgo. Su edad media fue 9,5 (DE=4,7) años y el 54,1% eran varones. La media de enfermedades crónicas fue 1,1 (DE=0,4) y el 11,3% tenían multimorbilidad. Las enfermedades más prevalentes fueron: asma (6,1%), trastorno por déficit de atención e hiperactividad (TDAH) (1,8%) y obesidad (1,4%). La media de visitas/año al pediatra fue 4,9 (DE=6,3). Se asoció a mayor peso de complejidad la edad<5 años (coeficiente B [CB]=2,6; IC 95%=2,1; 3,1), número de enfermedades crónicas (CB=1,6; IC 95%=1,1; 2,1) y contactos anuales con AP (CB=0,1; IC 95%=0,06;0,11). CONCLUSIONES: En población pediátrica encontramos un número importante de pacientes con enfermedades crónicas, siendo el asma, el TDAH y la obesidad las enfermedades más prevalentes. El uso de servicios de AP fue elevado. La mayor complejidad responde a la edad lactante y la preescolar, a la multimorbilidad y a los mayores contactos con AP

INTRODUCTION: Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG. PATIENTS AND METHODS: A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed. RESULTS: A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight. CONCLUSIONS: A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC

[Chronic diseases in the paediatric population: Comorbidities and use of primary care services]. / Enfermedades crónicas en población pediátrica: comorbilidades y uso de servicios en atención primaria.

INTRODUCTION: Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG. PATIENTS AND METHODS: A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed. RESULTS: A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight. CONCLUSIONS: A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC.

[Health services utilization in Primary Care in patients with chronic conditions according to risk levels]. / Utilización de los servicios de salud de Atención Primaria en los pacientes crónicos según nivel de riesgo.

OBJECTIVE: Chronic patients suffer a greater number of health problems and have greater needs for assistance and care. The objective was to describe the use of health services in Primary Care in patients with chronic conditions according to risk level by adjusted morbidity groups (AMG) and analyze the associated factors. METHODS: Cross-sectional study. We included patients ≥18 years-old identified as chronic by the stratification tool according to AMG in a basic health area in the Community of Madrid with an assigned population of 18,107 inhabitants. Sociodemographic, clinical-care and use of services variables were collected and were classified according to the "behavioral" model in predisposing, need or facilitators factors. Univariate, bivariate and multiple linear regression adjusted with robust estimators was performed. RESULTS: 9,443 chronic patients (52.1% of the population in the selected zone) were identified, mean age of 57.8 (SD=18.7); 62.1% women. According to their risk level 4.7% were high risk, 18.7% medium risk and 76.6% low risk. The mean number of contacts per year was 14.1 (SD=15.2); 34.4 (SD=27.9) in high risk; 21.8 (SD=17.2) in medium risk and 10.1 (SD=10.2) in low risk. 7.5 (SD=7.1) contacts were with the doctor and 12.9 (SD=12.9) were face-to-face. The factors associated with higher use of services were high risk (Coefficient B[CB]=12.6; IC95%=11-14.2), immobilization (CB=8.8; IC95%=7.3-10.4), polypharmacy (CB=6; IC95%=5-8.6), female sex (CB=1; IC95%=0.4-1.5), number of chronic diseases (CB=1; IC95%=0.8-1.2) and age (CB=0.03; IC95%=0.01-0.05). CONCLUSIONS: The health services utilization in Primary Care in chronic patients is high and increased according with the risk level by AMG. The contact with the doctor is superior to nurse and the most frequent type is face-to-face. The greater utilization of services responds to predisposing factors (female sex and age) and above all to need factors (high risk, immobility, multimorbidity and polypharmacy).

OBJETIVO: Los pacientes crónicos sufren mayor número de problemas de salud y tienen mayores necesidades de asistencia y cuidados. El objetivo de este estudio fue describir la utilización de servicios de salud de Atención Primaria en los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA), así como analizar los factores asociados. METODOS: Se realizó un estudio transversal. Se incluyeron pacientes ≥ 18 años identificados como crónicos por el estratificador GMA en una zona básica de salud de la Comunidad de Madrid, con una población adscrita de 18.107 habitantes. Se recogieron variables sociodemográficas, clínico-asistenciales y de utilización de servicios, y se clasificaron según el modelo "conductual" en "factores predisponentes", "factores de necesidad" o "factores facilitadores". Se empleó un análisis univariado, bivariado y multivariante, ajustando un modelo de regresión lineal múltiple con estimadores robustos. RESULTADOS: Se incluyeron 9.443 pacientes crónicos (el 52,1% de la población de la zona seleccionada), con una edad media de 57,8 años (Desviación estándar [DE]=18,7), siendo mujeres el 62,1%. El 4,7% eran pacientes de alto riesgo, el 18,7% de medio riesgo y el 76,6% presentaba bajo riesgo. La media de contactos/año fue de 14,1 (DE=15,2). 34,4 (DE=27,9) en alto riesgo, 21,8 (DE=17,2) en riesgo medio y 10,1 (DE=10,2) en bajo riesgo. De estos contactos, 7,5 (DE=7,1) fueron con médico y 12,9 (DE=12,9) presenciales. Los factores asociados a mayor utilización fueron el riesgo alto (Coeficiente B [CB]=12,6; IC95%=11,1-14,2), el estar inmovilizado (CB=8,8; IC95%=7,3-10,4), la polimedicación (CB=6; IC95%=5,1-6,9), el ser mujer (CB=1; IC95%=0,4-1,5), el número de enfermedades crónicas (CB=1; IC95%=0,8-1,2) y la edad (CB=0,03; IC95%=0,01-0,05). CONCLUSIONES: La utilización de servicios de Atención Primaria en los pacientes crónicos es elevada y aumenta según el nivel de riesgo asignado por los GMA. El contacto con el médico es superior frente al de la enfermería, y el tipo más frecuente es presencial. La mayor utilización responde a factores predisponentes (ser mujer y la edad) y, sobre todo, de necesidad clínica (alto riesgo, multimorbilidad, polimedicación e inmovilidad).

Utilización de los servicios de salud de Atención Primaria en los pacientes crónicos según nivel de riesgo / Health services utilization in Primary Care in patients with chronic conditions according to risk levels

OBJETIVO: Los pacientes crónicos sufren mayor número de problemas de salud y tienen mayores necesidades de asistencia y cuidados. El objetivo de este estudio fue describir la utilización de servicios de salud de Atención Primaria en los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA), así como analizar los factores asociados. MÉTODOS: Se realizó un estudio transversal. Se incluyeron pacientes ≥ 18 años identificados como crónicos por el estratificador GMA en una zona básica de salud de la Comunidad de Madrid, con una población adscrita de 18.107 habitantes. Se recogieron variables sociodemográficas, clínico-asistenciales y de utilización de servicios, y se clasificaron según el modelo "conductual" en "factores predisponentes", "factores de necesidad" o "factores facilitadores". Se empleó un análisis univariado, bivariado y multivariante, ajustando un modelo de regresión lineal múltiple con estimadores robustos. RESULTADOS: Se incluyeron 9.443 pacientes crónicos (el 52,1% de la población de la zona seleccionada), con una edad media de 57,8 años (Desviación estándar [DE]=18,7), siendo mujeres el 62,1%. El 4,7% eran pacientes de alto riesgo, el 18,7% de medio riesgo y el 76,6% presentaba bajo riesgo. La media de contactos/año fue de 14,1 (DE=15,2). 34,4 (DE=27,9) en alto riesgo, 21,8 (DE=17,2) en riesgo medio y 10,1 (DE=10,2) en bajo riesgo. De estos contactos, 7,5 (DE=7,1) fueron con médico y 12,9 (DE=12,9) presenciales. Los factores asociados a mayor utilización fueron el riesgo alto (Coeficiente B [CB]=12,6; IC95%=11,1-14,2), el estar inmovilizado (CB=8,8; IC95%=7,3-10,4), la polimedicación (CB=6; IC95%=5,1-6,9), el ser mujer (CB=1; IC95%=0,4-1,5), el número de enfermedades crónicas (CB=1; IC95%=0,8-1,2) y la edad (CB=0,03; IC95%=0,01-0,05). CONCLUSIONES: La utilización de servicios de Atención Primaria en los pacientes crónicos es elevada y aumenta según el nivel de riesgo asignado por los GMA. El contacto con el médico es superior frente al de la enfermería, y el tipo más frecuente es presencial. La mayor utilización responde a factores predisponentes (ser mujer y la edad) y, sobre todo, de necesidad clínica (alto riesgo, multimorbilidad, polimedicación e inmovilidad)

OBJECTIVE: Chronic patients suffer a greater number of health problems and have greater needs for assistance and care. The objective was to describe the use of health services in Primary Care in patients with chronic conditions according to risk level by adjusted morbidity groups (AMG) and analyze the associated factors. METHODS: Cross-sectional study. We included patients ≥18 years-old identified as chronic by the stratification tool according to AMG in a basic health area in the Community of Madrid with an assigned population of 18,107 inhabitants. Sociodemographic, clinical-care and use of services variables were collected and were classified according to the "behavioral" model in predisposing, need or facilitators factors. Univariate, bivariate and multiple linear regression adjusted with robust estimators was performed. RESULTS: 9,443 chronic patients (52.1% of the population in the selected zone) were identified, mean age of 57.8 (SD=18.7); 62.1% women. According to their risk level 4.7% were high risk, 18.7% medium risk and 76.6% low risk. The mean number of contacts per year was 14.1 (SD=15.2); 34.4 (SD=27.9) in high risk; 21.8 (SD=17.2) in medium risk and 10.1 (SD=10.2) in low risk. 7.5 (SD=7.1) contacts were with the doctor and 12.9 (SD=12.9) were face-to-face. The factors associated with higher use of services were high risk (Coefficient B[CB]=12.6; IC95%=11-14.2), immobilization (CB=8.8; IC95%=7.3-10.4), polypharmacy (CB=6; IC95%=5-8.6), female sex (CB=1; IC95%=0.4-1.5), number of chronic diseases (CB=1; IC95%=0.8-1.2) and age (CB=0.03; IC95%=0.01-0.05). CONCLUSIONS: The health services utilization in Primary Care in chronic patients is high and increased according with the risk level by AMG. The contact with the doctor is superior to nurse and the most frequent type is face-to-face. The greater utilization of services responds to predisposing factors (female sex and age) and above all to need factors (high risk, immobility, multimorbidity and polypharmacy)