Community Activities in Primary Care: A Literature Review.

Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.

Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial.

BACKGROUND: The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD).  METHODS: Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45-75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor's office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. RESULTS: Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9-17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG. CONCLUSIONS: A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211.

Effectiveness of mobile applications in diabetic patients' healthy lifestyles: A review of systematic reviews.

OBJECTIVE: (1) Examine the mobile applications that address lifestyles to improve the metabolic control of adult patients with diabetes mellitus. (2) Describe the characteristics of the used mobile applications, identify the healthy lifestyles they target, and describe any of their adverse effects. METHODS: Review systematic reviews. We included studies that used any mobile application to help patients improve diabetes mellitus self-management by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care with no mobile devices. In May 2018, Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct were searched, updated in June 2021. The methodological quality of the studies was assessed by the Amstar-2 tool. RESULTS: First 804 articles were analyzed to select 17 systematic reviews, of which the methodological quality of seven was high or moderate. Interventions lasted 1-12 months. Twenty-three different mobile applications were identified that were all related to eating and physical activity. Significant changes were noted in HbA1c values. No clear improvement was observed for weight/BMI, lipid profile, quality of life or blood pressure. No adverse effects were found. CONCLUSIONS: Managing the lifestyle of patients with diabetes using mobile applications improves short-term glycemic control, but the long-term results are not conclusive. The identified mobile applications focus on food and physical activity. Most are free. No adverse effects caused by using them were identified. PROSPERO REGISTER: CRD42019133685.

Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study).

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.

[Baseline characteristics and quality of life in patients with Diabetes Mellitus included in the EIRA randomized clinical trial.] / Características basales y calidad de vida de los pacientes con Diabetes mellitus incluidos en el ensayo clínico aleatorizado EIRA.

OBJECTIVE: The EIRA study is a randomized clinical multicenter trial that aims to evaluate the effectiveness of a complex multi-risk intervention aimed at people aged 45-75 in Primary Care. The objectives of this work were to describe the baseline characteristics of patients with Diabetes Mellitus included in phase III of the EIRA study and analyze the relationship that different independent variables may have with the quality of life. METHODS: The data of all patients with Diabetes Mellitus that were included in phase III of EIRA study collected at baseline were analyzed. Patients with at least two or more of unhealthy lifestyles were selected: smoking, low adherence to the Mediterranean diet and/or low level of physical activity. The quality of life was measured with the EQ-5D-5L questionnaire. A descriptive and bivariate study was performed. The variables did not follow a normal distribution. Non-parametric statistical tests were used. For the multivariate analysis of the quality of life, automated linear regression was used with SPSS v19. RESULTS: 694 were patients included with Diabetes Mellitus (356 controls, 338 in intervention, without significant differences between both groups). Control: 37.64% women, age (median) 60 years. Intervention: 37.87% women, age (median) 60 years. Most prevalent risk behaviors in descending order: low adherence to the Mediterranean diet, low level of physical activity and smoking. The variables that significantly influenced quality of life were: GAD-7, work activity, HbA1c and CIDI. CONCLUSIONS: There are no significant differences motivated by the study design. The influence of mental health on the EQ-5D-5L is remarkable.

OBJETIVO: El estudio EIRA es un ensayo clínico aleatorizado multicéntrico que pretende evaluar la efectividad de una intervención compleja multirriesgo dirigida a personas de 45-75 años atendidas en Atención Primaria. Los objetivos de este trabajo fueron describir las características basales de los pacientes con Diabetes Mellitus incluidos en la fase III del estudio EIRA, y analizar la relación que puedan tener las diferentes variables independientes con la calidad de vida. METODOS: Se analizaron los datos recogidos al inicio del estudio de todos los pacientes con Diabetes Mellitus que se incluyeron en la fase III del estudio EIRA. Se seleccionaron pacientes con dos o más estilos de vida no saludables: tabaquismo, baja adherencia a dieta mediterránea y/o bajo nivel de actividad física. La calidad de vida se midió con el cuestionario EQ-5D-5L. Se realizó un estudio descriptivo y bivariante. Las variables no siguieron una distribución normal. Se utilizaron test estadísticos no paramétricos. Para identificar factores influyentes en la calidad de vida, se utilizó regresión lineal automatizada con SPSS v19. RESULTADOS: Se incluyeron 694 pacientes con Diabetes Mellitus (356 controles, 338 en intervención, sin diferencias significativas entre ambos grupos). Control: 37,64% mujeres, edad (mediana) 60 años. Intervención: 37,87% mujeres, edad (mediana) 60 años. Comportamientos de riesgo más prevalentes en orden descendente: baja adherencia a dieta mediterránea, bajo nivel de actividad física y tabaquismo. Las variables que influyeron significativamente en la calidad de vida fueron: GAD-7, actividad laboral, HbA1c y CIDI. CONCLUSIONES: No existen diferencias significativas motivadas por el diseño del estudio. Es destacable la influencia de la salud mental en el EQ-5D-5L.

[Clinical profile of patients diagnosed with type 2 Diabetes Mellitus]. / Perfil clínico de los pacientes diagnosticados de Diabetes Mellitus tipo 2 en el Área Sanitaria de Vigo.

OBJECTIVE: Type 2 Diabetes Mellitus is a chronic disease that represent an important problem of public health. The objective of this study was to describe the sociodemographic, anthropometric, metabolic control, comorbidity and cardiovascular risk characteristics of patients diagnosed with Diabetes Mellitus type 2 in the health area of Vigo. METHODS: Retrospective observational descriptive study. Between March and September 2016, it did telephone interview and an audit of electronic medical records to 195 patients ≥ 18 years old from the health area of Vigo diagnosed with type 2 Diabetes Mellitus. It selected by random sampling with replacement. It evaluated the cardiovascular risk using the method "United Kingdom Prospective Diabetes Study", the metabolic control with the recommendations of the "American Diabetes Association" 2016, and the comorbidity using the Charlson index. It performed a descriptive and bivariate analysis with R statistical package. RESULTS: The glycemic control was adequate (HbA1c less than 7.0%) in the 61.03% of the patients. The 58.46% had a blood pressure under 140/90mmHg, 52.82% had a total cholesterol under 185mg/dl and 66.15% had a triglyceride level under 150mg/dl. The 49.74% presented a high comorbidity (Charlson larger or the same as 3 points). The risk of suffering and/or dying of heart disease was 37.81%, and 23.50% of suffering and/or dying of a stroke in the next 10 years. CONCLUSIONS: Most diabetic patients of the health area of Vigo have a good control of their disease but they present a high index of comorbidity and high cardiovascular risk.

OBJETIVO: La Diabetes Mellitus tipo 2 es una enfermedad crónica que representa un importante problema de salud pública. El objetivo de este estudio fue describir las características sociodemográficas, las antropométricas, el control metabólico, la comorbilidad y el riesgo cardiovascular de los pacientes diagnosticados de Diabetes Mellitus tipo 2 del área sanitaria de Vigo. METODOS: Estudio descriptivo observacional retrospectivo. Entre marzo y setiembre de 2016, se realizó entrevista telefónica y auditoria de historia clínica electrónica a 195 pacientes ≥ 18 años del área sanitaria de Vigo diagnosticados de Diabetes Mellitus tipo 2. Se seleccionaron mediante muestreo aleatorio con reposición. Se evaluó el riesgo cardiovascular mediante el método "United Kingdom Prospective Diabetes Study", el control metabólico según las recomendaciones de la "American Diabetes Association" 2016, y la comorbilidad mediante el índice de Charlson. Se realizó un análisis descriptivo y bivariante con el paquete estadístico R. RESULTADOS: El control glucémico era adecuado (HbA1c menor de 7,0%) en el 61,03% de los pacientes. El 58,46% tenía una tensión arterial menor de 140/90mmHg, 52,82% un colesterol total menor de 185mg/dl y un 66,15% un nivel triglicéridos menor de 150 mg/dl. El 49,74% presentaron una comorbilidad alta (Charlson mayor o igual de 3 puntos). El riesgo de padecer y/o fallecer de una enfermedad cardíaca era del 37,81%, y del 23,50% el de padecer y/o fallecer de un accidente cerebrovascular en los próximos 10 años. CONCLUSIONES: La mayoría de los pacientes diabéticos del área sanitaria de Vigo tienen un buen control de su enfermedad pero presentan un alto índice de comorbilidad y un elevado riesgo cardiovascular.

Perfil clínico de los pacientes diagnosticados de Diabetes Mellitus 2 en el Área Sanitaria de Vigo / Clinical profile of patients diagnosed with type2 Diabetes Mellitus

Fundamentos. La Diabetes Mellitus tipo 2 es una enfermedad crónica que representa un importante problema de salud pública. El objetivo de este estudio fue describir las características sociodemográficas, las antropométricas, el control metabólico, la comorbilidad y el riesgo cardiovascular de los pacientes diagnosticados de Diabetes Mellitus tipo 2 del área sanitaria de Vigo. Método. Estudio descriptivo observacional retrospectivo. Entre marzo y setiembre de 2016, se realizó entrevista telefónica y auditoria de historia clínica electrónica a 195 pacientes ≥ 18 años del área sanitaria de Vigo diagnosticados de Diabetes Mellitus tipo 2. Se seleccionaron mediante muestreo aleatorio con reposición. Se evaluó el riesgo cardiovascular mediante el método "United Kingdom Prospective Diabetes Study", el control metabólico según las recomendaciones de la "American Diabetes Association" 2016, y la comorbilidad mediante el índice de Charlson. Se realizó un análisis descriptivo y bivariante con el paquete estadístico R. Resultados. El control glucémico era adecuado (HbA1c<7,0%) en el 61,03% de los pacientes. El 58,46% tenía una tensión arterial <140/90mmHg, 52,82% un colesterol total <185mg/dl y un 66,15% un nivel triglicéridos <150 mg/dl. El 49,74% presentaron una comorbilidad alta (Charlson ≥3 puntos). El riesgo de padecer y/o fallecer de una enfermedad cardíaca era del 37,81%, y del 23,50% el de padecer y/o fallecer de un accidente cerebrovascular en los próximos 10 años. Conclusiones. La mayoría de los pacientes diabéticos del área sanitaria de Vigo tienen un buen control de su enfermedad pero presentan un alto índice de comorbilidad y un elevado riesgo cardiovascular (AU)

Background. Type 2 Diabetes Mellitus is a chronic disease that represent an important problem of public health. The objective of this study was to describe the sociodemographic, anthropometric, metabolic control, comorbidity and cardiovascular risk characteristics of patients diagnosed with Diabetes Mellitus type 2 in the health area of Vigo. Method. Retrospective observational descriptive study. Between March and September 2016, it did telephone interview and an audit of electronic medical records to 195 patients ≥ 18 years old from the health area of Vigo diagnosed with type 2 Diabetes Mellitus. It selected by random sampling with replacement. It evaluated the cardiovascular risk using the method "United Kingdom Prospective Diabetes Study", the metabolic control with the recommendations of the "American Diabetes Association" 2016, and the comorbidity using the Charlson index. It performed a descriptive and bivariate analysis with R statistical package. Results. The glycemic control was adequate (HbA1c<7.0%) in the 61.03% of the patients. The 58.46% had a blood pressure <140/90mmHg, 52.82% had a total cholesterol <185mg/dl and 66.15% had a triglyceride level <150mg/dl. The 49.74% presented a high comorbidity (Charlson ≥3 points). The risk of suffering and/or dying of heart disease was 37.81%, and 23.50% of suffering and/or dying of a stroke in the next 10 years. Conclusions. Most diabetic patients of the health area of Vigo have a good control of their disease but they present a high index of comorbidity and high cardiovascular risk (AU)

Situación actual de la especialidad de Enfermería Familiar y Comunitaria en España / State speciality Family and Community Nursing in Spain

Objetivo: Conocer la realidad sobre la aplicación del programa formativo en cada una de las Unidades Multiprofesionales de Atención Familiar y Comunitaria, y también describir la situación actual y perspectivas laborales de los actuales especialistas de Enfermería Familiar y Comunitaria. Método: Estudio descriptivo de corte transversal realizado durante los meses de Septiembre y Octubre del 2014 a los profesionales residentes y especialistas de Enfermería Familiar y Comunitaria de toda España. Para obtener los datos se facilitó de forma online un cuestionario autoadministrado de carácter voluntario y anónimo, el cual fue elaborado por un grupo de expertos en la especialidad de Enfermería Familiar y Comunitaria pertenecientes a la Asociación Gallega de Enfermería Familiar y Comunitaria de Galicia (AGEFEC). Resultados: Se estudió una muestra de 342 profesionales. El 69% eran residentes y el 31% especialistas en Enfermería Familiar y Comunitaria. El 54% de los especialistas y el 56% de los residentes indican un déficit en la adquisición de competencias recogidas en el programa formativo de su especialidad. El 46% de los especialistas está trabajando actualmente en el ámbito de la Atención Primaria. Conclusiones: Resulta de vital importancia ofrecer una formación especializada en Enfermería Familiar y Comunitaria lo más homogenizada posible, sirviendo como un instrumento necesario para garantizar la calidad de la formación en todo el sistema sanitario (AU)

Objective: Knowing the reality on the implementation of the training program in each of the teaching units Multiprofessional Family Care and Community, and also to describe the current situation and perspectives of current labor specialists of Family and Community Nursing. Method: Descriptive cross-sectional study conducted during the months of September and October 2014 resident`s professionals and specialists of Family and Community Nursing throughout Spain. For data was provided so online a self-administered questionnaire voluntary and anonymous, which was developed by a group of experts in the specialty of Family and Community Nursing belonging to the Galician Association of Family and Community Nursing Galicia (AGEFEC). Results: A sample of 342 professionals was studied. 69% were residents and 31% specialists in Family and Community Nursing. 54% of specialists and 56% of residents indicate a deficit in the acquisition of skills included in the training program for their specialty. 46% of specialists are currently working in the field of primary care. Conclusions: It is important to provide a specialized training Family and Community Nursing homogenized as possible, serving as a necessary step to ensure the quality of training throughout the health system instrument (AU)

[Did the patients with chronic obstructive pulmonary disease in Primary Care center Anton de Borja correctly utilize inhalers?]. / ¿Utilizan correctamente los inhaladores los pacientes con enfermedad pulmonar obstructiva crónica del centro de Atención Primaria Antón de Borja?

OBJECTIVE: To determine the percentage of patients with Pulmonary Obstructive Chronic Disease who doing of incorrect form the inhaler technique. METHOD: Descriptive transversal study made in the Primary Care Center "Antón de Borja" of Rubi (in Barcelona) during the period between May and December 2013, where it was studied a representative sample of 200 patients. To assess the inhaler technique was performed a personal interview with the patient in which it was requested him to carry out a demonstration of how he was using his inhaler regularly evaluating his inhaler technique by means of the regulations established by Spanish Society of Pneumology and Thoracic Surgery. RESULTS: 43% of the patients carry out inhaler technique incorrectly. The percentage of inadequate use of inhalers of dry powder was 26%, of the pressurized cartridge 38% and the inhaler chamber 10%. 82% of patients ≥ 65 years who have prescribed a pressurized inhaler cartridge do not perform accompanied by an inhaler chamber. CONCLUSIONS: A high percentage of patients do not correctly carry out inhaler technique, pointing the rare use made of the inhaler chamber despite its proven efficacy and the high number of patients with pressurized inhaler cartridge. These results reflect the need for the implementation of an educational program in our Primary Care Center to teach patients to use inhaler devices.