Más allá del COVID-19. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria / Beyond COVID-19. Design of a new model of shared services between community pharmacies and primary health care

INTRODUCCIÓN: Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. OBJETIVO: Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. MÉTODO: Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. RESULTADOS: Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. CONCLUSIONES: Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados

INTRODUCTION: Community pharmacies play a key role in response to COVID-19 and especially in the control of chronic diseases beyond the pandemic. OBJECTIVE: To design a new model of health assistance focused on frailty prevention and the self-care promotion among older adults, using share care services between the community pharmacy and the primary healthcare. METHOD: We conducted a qualitative study of action research using methods as actor mapping, segment profile, discussion groups, in-depth interviews and creative design sessions. Using those techniques during all the design stages allowed us to get an effective participation of older adults and professionals. RESULTS: Common communications circuits for the new services, new professional roles and shared action protocols were created. Furthermore, we designed early frailty detection, medication review associated with fall risk, assessment and intervention for adherence to new medications, vital sign checking and hypertension, diabetes and COPD therapeutic reinforcement services. This model provides two-way communication systems with the primary health care and recognizes the community pharmacy functions in the scope of self-care promotion and chronic pathology and medication self-management. CONCLUSIONS: It is highlighted the importance of creating a more open ecosystem within the community. The feedback obtained will allow to design organizational innovations. This has to be done taking advantage of the community pharmacies proximity and capillarity in the territory, as well as the new incorporation of the omni-channel care. Besides, cooperative design techniques have proved to be an encouragement for the participation of the involved agents, increasing their contribution and potential impact on the results

Risk of suicide in households threatened with eviction: the role of banks and social support.

BACKGROUND: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. METHODS: A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. RESULTS: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. CONCLUSIONS: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

La salud de las personas adultas afectadas por un proceso de desahucio / The health of adults undergoing an eviction process

Objetivo: Analizar el estado de salud percibida, y otros indicadores relacionados con la salud, en personas adultas de Granada que se encuentran en un proceso de desahucio de su vivienda habitual, de alquiler o en propiedad, en comparación con la salud de la población general andaluza. Métodos: Estudio transversal mediante encuesta administrada por personal entrenado que incluye instrumentos de la Encuesta Andaluza de Salud 2011 para la medición de variables de salud física y mental, y de hábitos relacionados con la salud. Se han comparado los resultados con los obtenidos sobre la población general andaluza mediante la Encuesta Andaluza de Salud. Se ha realizado un análisis bivariado utilizando la prueba de ji al cuadrado, y un análisis multivariado mediante regresión logística. Resultados: Se ha obtenido una muestra total de 205 personas en proceso de desahucio. El 59,5% (122) son mujeres y el 40,5% (83) hombres. Presentan una mayor probabilidad de tener una salud deficiente (odds ratio [OR]: 12,63; intervalo de confianza del 95% [IC95%]: 8,74-18,27), enfermedad cardiovascular (OR: 3,08; IC95%:1,54-6,16) o consumir tabaco (OR: 1,68; IC95%: 1,21-2,33), en comparación con la población general andaluza. La mayoría de los indicadores analizados muestran un peor resultado para las mujeres que experimentan un proceso de desahucio. Conclusiones: Nuestros resultados indican que las personas afectadas por un proceso de desahucio en Granada y su área metropolitana, en el actual contexto de crisis, expresan una peor salud en relación a la población general andaluza. Es necesario seguir investigando sobre la salud y los desahucios, desde diferentes aproximaciones metodológicas, para una mejor comprensión de este problema (AU)

Objective: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. Methods: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the ji2 test and a multivariate logistic regression analysis were conducted. Results: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. Conclusions: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic (AU)

[The health of adults undergoing an eviction process]. / La salud de las personas adultas afectadas por un proceso de desahucio.

OBJECTIVE: To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. METHODS: A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the χ2 test and a multivariate logistic regression analysis were conducted. RESULTS: We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. CONCLUSIONS: Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic.

Expectativas y necesidades detectadas en profesionales de organizaciones provinciales que trabajan en acción intersectorial en salud / Expectations and needs detected among professionals at provincial organizations working in intersectorial action in health

Fundamentos: La Acción Intersectorial en Salud (AIS) ha sido la metodología propuesta para la reducción de la desigualdad en salud. Los objetivos del presente estudio son conocer las experiencias, expectativas y necesidades percibidas de los profesionales que trabajan en organizaciones provinciales, para proponer un marco de análisis y desarrollo de trabajo intersectorial. Métodos: Con un diseño cualitativo se realizaron 21 entrevistas individuales semiestructuradas durante el mes de julio de 2005 a profesionales de organizaciones provinciales de justicia, educación, salud, igualdad y bienestar social y de fuerzas y cuerpos de seguridad en Granada y Sevilla. Se utilizó un muestreo intencional «en bola de nieve» en el que a través de dos informantes clave se logró completar el cuadro de perfiles. Resultados: Los profesionales identifican necesidades que habrían de ser cubiertas con el trabajo intersectorial así como los fundamentos del mismo. Destacan una serie de características personales y algunas relacionadas con la organización e identifican factores que han sido divididos en políticos, sociales y operativos. Conclusiones: Hay un consenso en señalar la acción intersectorial como garante para reducir la desigualdad social, ya que evita la duplicidad de recursos y unifica la respuesta que se ofrece. Resulta básico abordar cambios profundos previos en la cultura de las organizaciones provinciales para que el trabajo intersectorial forme parte de las mismas. Tales cambios han de ir acompañados de directrices políticas claras en los niveles superiores y de movimientos sociales que visibilicen la necesidad de una determinada acción intersectorial

Background: Intersectorial Action in Health has been the methodology proposed for reducing inequality in health. The objectives of this study are to ascertain what experiences, expectations and needs are perceived to exist among the professionals working at provincial organizations in order to propose a framework for analyzing and carrying out intersectorial work. Methods: With a qualitative design, 21 semi-structured individual surveys were conducted in July 2005 of professionals from provincial justice, education, health, equality and welfare organization and from law enforcement officials in Granada and Seville. An intentional «snowball» sampling was used, in which it was possible to complete the profile table by way of two individuals answering the survey. Results: The professionals identified needs which it would be necessary to cover with the intersectorial work as well as the grounds for the same. They highlighted a number of personal traits and some organization-related ones and identified factors which have been divided among, political, social and operative factors. Conclusions: A consensus exists as to pointing out intersectorial action as a way of guaranteeing the reduction of social inequality, given that it prevents doubling resources and unifies the response being provided. It was thought to be fundamental for some profound changes to first be made in the provincial organizations culture in or for the intersectorial work to comprise part thereof. These changes must go along with clear-cut guidelines at the upper levels of social movements which will clearly highlight the need for a certain intersectorial action in particular