De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia / From face-to-face consultation to teleconsultation: Primary health care professionals’ experiences in the Basque Country during the pandemic

Objetivo: Explorar las percepciones de profesionales de Atención Primaria (AP) sobre los cambios en las modalidades de consulta y su impacto en los fundamentos de la AP durante la pandemia. Diseño: Investigación cualitativa de diseño exploratorio realizada entre octubre y noviembre de 2021. Emplazamiento: Cuatro centros de salud urbanos y uno rural con diferente perfil socioeconómico en los tresterritorios del País Vasco. Participantes: Cuarenta y seis profesionales de distintas categorías del equipo de AP y directores/as de centros de salud.Método: Muestreo intencional. Cinco grupos focales y cuatroentrevistas en profundidad. Análisis temático con apoyo del programa Atlas.Ti. Triangulación de los resultados entre el equipo investigador. Resultados: Las vivencias sobre el desarrollo de la teleconsulta aparecen directamente condicionadas por el contexto pandémico en sus diferentes fases y por la situación de la AP. Los y las profesionales identificaron barreras comunicacionales, así como potencialidades de su uso que requieren de formación y evaluación adecuadas. Se percibieron riesgos de inequidad en la utilización de las teleconsultas que podrían estar afectando a la calidad asistencial. La longitudinalidad se valoró como un factor facilitador y se identificaron problemas en la coordinación y comunicación mediante teleconsulta entre niveles asistenciales. Conclusiones: La sustitución de la consulta presencial por la teleconsulta tuvo impacto en aspectos fundamentales de la AP como la calidad, accesibilidad, equidad, coordinación y longitudinalidad. La teleconsulta en AP requiere siempre ser evaluada considerando las circunstancias y los contextos concretos de su implementación

Objective: To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. Design: Qualitative exploratory research conducted between October and November, 2021. Location: Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. Participants: Forty-six professionals from different categories of the PHC team and health centre directors.Method: Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. Results: Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. Conclusions: The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.(AU)

[From face-to-face consultation to teleconsultation: Primary health care professionals' experiences in the Basque Country during the pandemic]. / De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia.

OBJECTIVE: To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DESIGN: Qualitative exploratory research conducted between October and November, 2021. LOCATION: Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. PARTICIPANTS: Forty-six professionals from different categories of the PHC team and health centre directors. METHOD: Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. RESULTS: Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. CONCLUSIONS: The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.

Monitorización de la COVID-19 en España: ¿es posible un análisis con perspectiva de género? / Monitoring COVID-19 in Spain: is a gender analysis possible?

Objetivo: Analizar la desagregación por sexo y la disponibilidad de indicadores de género en los informes de la Red Nacional de Vigilancia Epidemiológica (RENAVE) y el Estudio Nacional de Sero-Epidemiología (ENE-COVID-19). Método: Revisión por pares de los indicadores disponibles en 72 informes de la RENAVE y cuatro rondas del estudio ENE-COVID-19 para calcular el porcentaje de los desagregados por sexo y su variación temporal. Resultados: En marzo de 2021, el 52,4% de los indicadores RENAVE estaban desagregados por sexo. Desde julio de 2020, el 54% de los indicadores desagregados dejaron de publicarse y el 23% perdieron su desagregación. En el estudio ENE-COVID-19, la primera ronda incorporó el 88,23% de los indicadores desagregados y la 4ª el 94,74%. La 2ª y 3ª no desagregan por sexo. Conclusiones: Los informes RENAVE no permiten un análisis con perspectiva de género, y el estudio ENE-COVID-19 es el que más información aporta sobre determinantes sociales. (AU)

Objective: To analyse the sex disaggregation and availability of gender indicators in the reports of the National Epidemiological Surveillance Network (RENAVE) and the National Study of Sero-Epidemiology (ENE-COVID-19). Method: Peer review of indicators available in 72 RENAVE reports and 4 rounds of the ENE-COVID-19 study to calculate the percentage of those disaggregated by sex and their variation over time. Results: In March 2021, 52.4% of RENAVE indicators were disaggregated by sex. From July 2020, 54% of disaggregated indicators ceased to be published and 23% lost their disaggregation. In the ENE-COVID-19 study, the 1st round 88,23% of the indicators are disaggregated and the 4th round 94,74%. The 2nd and 3rd round do not disaggregated by sex. Conclusions: The RENAVE reports do not allow for a gender-sensitive analysis while the ENE-COVID-19 study provides the most information on social determinants. (AU)

Desigualdad de género y medicalización de la salud mental: factores socioculturales determinantes desde el análisis de percepciones expertas / Gender inequality and mental health medicalization: Sociocultural determining factors from the analysis of expert perceptions Departamento de Sociología y Trabajo Social

Objetivo: Identificar las raíces socioculturales que explican la mayor frecuencia de diagnósticos de depresión y/o ansiedad y de prescripción de psicofármacos en las mujeres, con el fin de proponer un marco explicativo preliminar para la investigación de las desigualdades de género en la salud mental y su medicalización. Diseño: Estudio cualitativo con un diseño descriptivo-interpretativo, a través de entrevistas en profundidad realizadas en enero y febrero de 2021. Emplazamiento Las entrevistas se realizaron en diversas ciudades del País Vasco, Barcelona y Madrid. Participantes y/o contexto: Se incluyeron 12 personas expertas en género y salud mental del ámbito clínico (Atención Primaria y Salud Mental), académico y asociativo. Método: Muestreo intencional, siguiendo la técnica de bola de nieve, hasta cubrir la diversidad de perfiles previamente identificados y la saturación del discurso. Se realizó un análisis de contenido temático partiendo de una perspectiva epistemológica crítica-realista. Resultados: Los factores principales identificados que pueden explicar las desigualdades de género en los diagnósticos de depresión o ansiedad y de prescripción de psicofármacos fueron 1) La subordinación material y simbólica de las mujeres, 2) el papel de las ciencias «psi» en la patologización de lo femenino, 3) los sesgos epistemológicos y androcéntricos de la biomedicina, y 4) la agencia activa de las mujeres en los procesos de medicalización. Conclusiones: La reducción de las desigualdades de género en los diagnósticos y la prescripción de psicofármacos requerirá de la intervención conjunta en los planos clínico, comunitario y estructural que, desde una perspectiva feminista, logren revertir la posición de vulnerabilidad socioeconómica, simbólica y epistémica de las mujeres.(AU)

To identify the sociocultural roots that explain the higher frequency of diagnoses of depression and/or anxiety and the prescription of psychotropic drugs in women, in order to propose a preliminary explanatory framework for the investigation of gender inequalities in mental health and its medicalization. Qualitative study with a descriptive–interpretive design, through in-depth interviews conducted in January and February 2021. Interviews were held in various cities of the Basque Country, Barcelona and Madrid. 12 experts in gender and mental health from the clinical (Primary Care and Mental Health), academic and associative fields. Intentional sampling, following the snowball technique, until covering the diversity of previously identified profiles and the saturation of the discourse. An analysis of thematic content was carried out starting from a critical-realistic epistemological perspective. The main dimensions to explain gender inequalities in diagnoses of depression or anxiety and prescription of psychoactive drugs were: 1) the material and symbolic subordination of women, 2) the role of «psi» sciences in the pathologization of the feminine identity, 3) the epistemological and androcentric biases of biomedicine, and 4) the active agency of women in medicalization processes. The reduction of gender inequalities in the diagnoses and prescription of psychotropic drugs will require joint intervention at the clinical, community and structural levels that, from a feminist perspective, manage to reverse the socioeconomic, symbolic and epistemic vulnerability of women.(AU)

[Gender inequality and mental health medicalization: Sociocultural determining factors from the analysis of expert perceptions]. / Desigualdad de género y medicalización de la salud mental: factores socioculturales determinantes desde el análisis de percepciones expertas.

To identify the sociocultural roots that explain the higher frequency of diagnoses of depression and/or anxiety and the prescription of psychotropic drugs in women, in order to propose a preliminary explanatory framework for the investigation of gender inequalities in mental health and its medicalization. Qualitative study with a descriptive-interpretive design, through in-depth interviews conducted in January and February 2021. Interviews were held in various cities of the Basque Country, Barcelona and Madrid. 12 experts in gender and mental health from the clinical (Primary Care and Mental Health), academic and associative fields. Intentional sampling, following the snowball technique, until covering the diversity of previously identified profiles and the saturation of the discourse. An analysis of thematic content was carried out starting from a critical-realistic epistemological perspective. The main dimensions to explain gender inequalities in diagnoses of depression or anxiety and prescription of psychoactive drugs were: 1) the material and symbolic subordination of women, 2) the role of «psi¼ sciences in the pathologization of the feminine identity, 3) the epistemological and androcentric biases of biomedicine, and 4) the active agency of women in medicalization processes. The reduction of gender inequalities in the diagnoses and prescription of psychotropic drugs will require joint intervention at the clinical, community and structural levels that, from a feminist perspective, manage to reverse the socioeconomic, symbolic and epistemic vulnerability of women.

Percepciones y experiencias de la población ante la transformación de la modalidad de las consultas en atención primaria durante la pandemia / Population's perceptions and experiences of the changing pattern of primary care consultations during the pandemic

Objetivo: Explorar las percepciones y experiencias de la población general ante el impacto de la implementación de la teleconsulta en atención primaria durante la pandemia.DiseñoMetodología cualitativa con un enfoque descriptivo-interpretativo, cuyo trabajo de campo se realizó entre mayo y noviembre de 2020.EmplazamientoEstudio realizado en Navarra y Euskadi.Participantes y/o contextosColectivos poblacionales con distintos perfiles de ciudadanía asociada y no asociada de ambas comunidades autónomas. En total participaron 62 personas usuarias de atención primaria y se realizaron 10 grupos focales.MétodoLos grupos focales siguieron un guion semiestructurado elaborado a partir de las variables de análisis y dimensiones de interés en función de los distintos perfiles de participantes y los objetivos. Las sesiones fueron grabadas y transcritas realizándose un análisis de contenido de carácter inductivo. Se llevó a cabo la triangulación de los datos para asegurar la validez.ResultadosLa percepción de la teleconsulta por parte de la población ha ido variando a lo largo de la pandemia y ha sido heterogénea. Los/las participantes consideran que la modalidad no presencial puede repercutir en la calidad asistencial, así como amplificar las desigualdades de acceso a atención primaria.ConclusionesResulta indispensable la realización de análisis y evaluaciones desde la perspectiva de equidad en salud para la toma de decisiones relacionadas con el uso de la tecnología en general y la teleconsulta en particular, en el futuro post-pandémico de la atención primaria.(AU)

Aim: To explore the perceptions and experiences of the general population regarding the impact of the implementation of teleconsultation in primary health care during the pandemic.Designmethodology with a descriptive–interpretative approach, whose fieldwork was carried out between May and November 2020.PlaceStudy conducted in Navarra and Euskadi. Population groups with different profiles of associated and non-associated citizenship in both Autonomous Communities. A total of 62 primary health care users have participated and 10 focus groups were carried out.MethodThe focus groups followed a semi-structured script based on the variables of analysis and dimensions of interest according to the different participant profiles and objectives. The sessions were recorded and transcribed. An inductive content analysis was performed. Data triangulation was realized in order to ensure validity.ResultsThe perception of teleconsultation by the population has varied throughout the pandemic and has been heterogeneous. The participants consider that the non-face-to-face modality may have repercussions on the quality of care, as well as amplifying inequalities in access to primary health care.ConclusionsIt is essential to carry out analyses and evaluations from a health equity perspective in order to make decisions related to the use of technology in general and teleconsultation in particular, in the post-pandemic future of primary health care.(AU)

Desde un diagnóstico de salud participativo en época de sindemia, a iniciativas de promoción de la salud en un municipio del País Vasco / From a participatory health diagnosis in times of syndemics, to health promotion initiatives in a municipality in the Basque Country

La sindemia por coronavirus ha producido un gran impacto en la salud de la población y ha aumentado aún más las desigualdades sociales. Es precisamente por eso por lo que resulta más necesario que nunca impulsar iniciativas de promoción de la salud orientadas a mejorar la salud y reducir dichas desigualdades. Los diagnósticos participativos pueden contribuir a generar y reforzar la consciencia colectiva acerca de los activos y necesidades relativas a la salud y el bienestar. El objetivo principal de este trabajo fue impulsar un proceso de acción comunitaria en el municipio de Arrigorriaga (País Vasco) con el fin de mejorar la salud en época de pandemia por COVID-19. Para ello, se realizó un diagnóstico de salud con un componente cualitativo y otro cuantitativo. Para el primero, se identificaron activos y necesidades en salud percibidos por diversos grupos de población del municipio. Para el segundo, se analizaron indicadores demográficos, relacionados con la salud y los determinantes sociales de la salud disponibles de los barrios y del municipio. La iniciativa surgió del Foro Sociosanitario del municipio. Para el diagnóstico cualitativo, se hizo un análisis de contenido de cuatro grupos focales con distintos colectivos del municipio, relacionados con labores de cuidados y personas en situación de vulnerabilidad, los cuales identificaron entre otros la soledad en personas mayores como una de las principales necesidades en salud, y como principal activo, el movimiento asociativo en el municipio. Para el diagnóstico cuantitativo, se hizo una revisión de indicadores en fuentes secundarias sobre la salud y los determinantes sociales de la salud del municipio.(AU)

The coronavirus syndemic has had a great impact on the health of the population, further increasing social inequalities. That is the reason why it is now more necessary than ever to promote health promotion initiatives aimed at improving health and reducing health inequalities. Participatory diagnostics can contribute to generating and reinforcing collective awareness of health assets and needs, and also wellbeing. The main objective of this process was to promote a process of community action in the municipality of Arrigorriaga (Basque Country) in order to improve health during the Covid-19 pandemic. To this end, a health diagnosis was carried out with a qualitative and a quantitative component. In the first instance, health assets and needs perceived by different population groups in the municipality were identified. In the second instance, demographic, health-related indicators and the social determinants of health available in the neighbourhoods and municipality were analysed. The initiative came from the municipality’s Social and Health Forum. For the qualitative diagnosis, a content analysis of four focus groups was carried out among different groups in the municipality, related to care work and people in vulnerable situations, which identified, among others, loneliness in the elderly as one of the main health needs and the main asset of the associative movement in the municipality. For the quantitative diagnosis, a review of indicators in secondary sources on health and the social determinants of health in the municipality was conducted. (AU)

Invisibilidad de género en la gestión de la COVID-19: ¿quién toma las decisiones políticas durante la pandemia? / Gender invisibility in the COVID-19 management: who are the policy decision-makers during the pandemic?

Objetivo: Analizar la composición por sexo de los comités de personas expertas creados para la gestión y la toma de decisiones políticas durante la pandemia de COVID-19 en España. Método: Se realizó una revisión por pares para identificar los comités destinados a la gestión de la COVID-19 en las comunidades autónomas y de ámbito estatal. Se recopilaron el nombre, el número de integrantes, el sexo y las fuentes de información, y se calculó el porcentaje de mujeres. Resultados: En las comunidades autónomas se identificó la composición de 11 comités específicos, con una media de representación de las mujeres del 39,2%, siendo del 42,9% en todo el Estado. El 75% del conjunto de los comités representó a las mujeres por debajo del umbral de paridad. Conclusiones: Existe una significativa infrarrepresentación de las mujeres en los comités para la gestión de la COVID-19, lo que puede limitar la necesaria mirada feminista para la recuperación de la crisis. (AU)

Objective: To analyse the gender composition of the advisory boards created for the management and policy decision-making during the COVID-19 pandemic in Spain. Method: A peer review was carried out to identify the advisory boards involved in the management of COVID-19 in the autonomous regions and in Spain. Name, number of members, sex and sources of information were collected, and the percentage of women was calculated. Results: At the regional level, the composition of eleven advisory boards was identified, with a mean representation of women of 39.2%; 42.9% at the national level. 75% of all boards represented women below the parity threshold. Conclusions: There is a significant under-representation of women in the advisory boards for the COVID-19 management, which may limit a necessary feminist perspective for the crisis recovery. (AU)

[Population's perceptions and experiences of the changing pattern of primary care consultations during the pandemic]. / Percepciones y experiencias de la población ante la transformación de la modalidad de las consultas en atención primaria durante la pandemia.

AIM: To explore the perceptions and experiences of the general population regarding the impact of the implementation of teleconsultation in primary health care during the pandemic. DESIGN: methodology with a descriptive-interpretative approach, whose fieldwork was carried out between May and November 2020. PLACE: Study conducted in Navarra and Euskadi. Population groups with different profiles of associated and non-associated citizenship in both Autonomous Communities. A total of 62 primary health care users have participated and 10 focus groups were carried out. METHOD: The focus groups followed a semi-structured script based on the variables of analysis and dimensions of interest according to the different participant profiles and objectives. The sessions were recorded and transcribed. An inductive content analysis was performed. Data triangulation was realized in order to ensure validity. RESULTS: The perception of teleconsultation by the population has varied throughout the pandemic and has been heterogeneous. The participants consider that the non-face-to-face modality may have repercussions on the quality of care, as well as amplifying inequalities in access to primary health care. CONCLUSIONS: It is essential to carry out analyses and evaluations from a health equity perspective in order to make decisions related to the use of technology in general and teleconsultation in particular, in the post-pandemic future of primary health care.

[Gender invisibility in the COVID-19 management: who are the policy decision-makers during the pandemic?] / Invisibilidad de género en la gestión de la COVID-19: ¿quién toma las decisiones políticas durante la pandemia?

OBJECTIVE: To analyse the gender composition of the advisory boards created for the management and policy decision-making during the COVID-19 pandemic in Spain. METHOD: A peer review was carried out to identify the advisory boards involved in the management of COVID-19 in the autonomous regions and in Spain. Name, number of members, sex and sources of information were collected, and the percentage of women was calculated. RESULTS: At the regional level, the composition of eleven advisory boards was identified, with a mean representation of women of 39.2%; 42.9% at the national level. 75% of all boards represented women below the parity threshold. CONCLUSIONS: There is a significant under-representation of women in the advisory boards for the COVID-19 management, which may limit a necessary feminist perspective for the crisis recovery.

[COVID-19 and gender: certainties and uncertainties in monitoring the pandemic.] / COVID-19 y género: certezas e incertidumbres en la monitori-zación de la pandemia.

OBJECTIVE: Highlighting gender inequalities during the pandemic and its relationship with other axes of social inequality will be decisive for its adequate monitoring. The aim of this study was to assess the differences between men and women in the main measures of infection and mortality by COVID-19, considering its temporal evolution, raising awareness about the weaknesses and contradictions between sources of information. METHODS: Cross-sectional analysis based on the microdata on COVID cases notified by the National Epidemiological Surveillance Network (RENAVE), the Death Statistics of the National Statistical Institute (INE) and the estimates of excess mortality from the INE and the Daily Mortality Monitoring System (MoMo) microdata. Standardized rates, prevalences and and ratios by sex were calculated for each indicator. The percentage of excess mortality without COVID-19 diagnosis in each sex was calculated. Male/female ratios for symptoms and risk factors of COVID-19 were also calculated. RESULTS: The rate of infection by COVID-19 was higher in women in the three waves of the pandemic, reaching 65% of infections during April and May 2020. Complications were between 1.5 and 2.5 times higher in men, especially in ICU admissions, which were 2.5 times more frequent than in women. Although mortality rates and excess mortality were also higher in men (around 1.8 times), the percentage of excess mortality without COVID-19 diagnosis was higher in women (44% in men vs. 52% in women the first wave). With regard to the symptoms of COVID-19, fever, cough, and dyspnoea were more frequent in men (20%, 10% and 19% more, respectively) compared to sore throat, vomiting or diarrhea that were more prevalent in women (90%, 40% and 10% more, respectively). CONCLUSIONS: The analysis disaggregated by sex has made it possible to identify differences between men and women in the diagnosis, presentation and severity of the COVID-19 that can help a better clinical and epidemiological approach to the disease. However, official sources present important gaps when presenting information disaggregated by sex. It is therefore necessary to advance in the inclusion of a gender perspective in the statistics on COVID-19, starting with a necessary but not sufficient condition such as the disaggregation by sex of the data.

OBJETIVO: Visibilizar las desigualdades de género durante la pandemia y su relación con otros ejes de desigualdad social resultará decisivo para su adecuada monitorización. El objetivo de este estudio fue analizar las diferencias entre hombres y mujeres en las principales medidas de contagio, complicaciones y mortalidad por la COVID-19 teniendo en cuenta la evolución temporal de las mismas a lo largo de la pandemia en el estado español, visibilizando las aportaciones y carencias entre fuentes de información. METODOS: Análisis transversal en base a los casos COVID notificados por la Red Nacional de Vigilancia Epidemiológica (RENAVE); las estimaciones de mortalidad del Instituto Nacional de Estadística (INE) y las estimaciones de exceso de mortalidad del INE y los microdatos del Sistema de Monitorización de la Mortalidad diaria (MoMo). Se calcularon tasas, prevalencias y ratios por sexo de cada indicador. Se calculó el porcentaje de exceso de mortalidad sin diagnóstico COVID-19 en cada sexo. Se calcularon, así mismo, las ratios hombres/mujeres para los síntomas y factores de riesgo de la COVID-19 recogidos. RESULTADOS: La tasa de infección por la COVID-19 fue superior en mujeres en las tres olas de la pandemia, llegando a constituir un 65% de las infecciones durante abril y mayo de 2020. Las complicaciones por coronavirus fueron entre 1,5 y 2,5 veces mayores en hombres de manera constante especialmente en las admisiones en UCI que llegaron a ser 2,5 veces más frecuentes que en mujeres. Si bien las tasas de mortalidad y el exceso de mortalidad fueron también superiores en hombres (en torno a 1,8 veces), el porcentaje de exceso de mortalidad sin diagnóstico COVID-19 fue superior en mujeres (44% en hombres frente a 52% en mujeres en la primera ola). Con respecto a los síntomas de la COVID-19, la fiebre, la tos y la disnea fueron más frecuentes en hombres (un 20%, 10% y 19% más, respectivamente) frente al dolor de garganta, vómitos o diarrea que se presentó más en mujeres (90%, 40% y 10% más, respectivamente). CONCLUSIONES: El análisis desagregado por sexo ha permitido identificar diferencias entre hombres y mujeres en el diagnóstico, presentación y gravedad de la COVID-19 que ayudarán a un mejor abordaje clínico y epidemiológico de la enfermedad. Sin embargo, las fuentes oficiales presentan importantes lagunas a la hora de presentar la información desagregada por sexo. Es por ello necesario avanzar en la inclusión de la perspectiva de género en la estadística sobre el COVID-19, empezando por una condición necesaria, pero no suficiente, como la desagregación por sexo de los datos.

¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria? / Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?

OBJETIVO: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). DISEÑO: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. PARTICIPANTES: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. RESULTADOS: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: -0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). CONCLUSIONES: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended

[Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?] / ¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria?

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended.

Comprehensive primary health care and non-communicable diseases management: a case study of El Salvador.

BACKGROUND: One of today's greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders' perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. METHODS: A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. RESULTS: The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. CONCLUSIONS: The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.