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.

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)

[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.

Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio / Benzoletter: minimal intervention for deprescribing benzodiazepines in patients with insomnia

OBJETIVO: Averiguar si una intervención mediante carta dirigida a usuarios de benzodiacepinas consigue disminuir su consumo. MÉTODO: Estudio antes-después sin grupo control realizado en atención primaria en mayo de 2016. A 1.582 pacientes que tomaban una única dosis diaria de una benzodiacepina como hipnótico durante más de 3 meses se les envió una carta personalizada de su médico de familia con información sobre los efectos desfavorables de dicho consumo y la recomendación para retirarlo, con una pauta de descenso escalonada (Benzocarta). Se evaluó el porcentaje de pacientes que cesaron el consumo de benzodiacepinas, el porcentaje que las disminuyeron y la diferencia en la dosis total dispensada (miligramos equivalentes de diazepam dispensados en 3 meses) entre el periodo preintervención y postintervención (a los 6 y 12 meses). RESULTADOS: Se obtuvieron datos de dispensaciones de 1.561 pacientes (media de edad: 69,3 años; 74% mujeres). Al año de la intervención, el 22,0% (intervalo de confianza del 95% [IC95%]:19,9-24,0) habían abandonado el consumo de benzodiacepinas y el 18,8% (IC95%:16,9-20,8) lo habían disminuido. Se observó una reducción estadísticamente significativa de la dosis total dispensada (media de la diferencia: 89mg; IC95%: 72,2-105,7). CONCLUSIÓN: La Benzocarta se asocia a una disminución relevante en el consumo de hipnóticos. Es una intervención sencilla y factible que puede aplicarse en poblaciones amplias, e incluso de forma repetida en el tiempo. Se requieren estudios controlados para confirmar su eficacia

OBJECTIVE: To determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption. METHOD: A before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated. RESULTS: Dispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89mg; 95%CI: 72.2-105.7). CONCLUSION: The Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness

«Consultas sagradas» en atención primaria: ¿qué suponen para el personal médico? / "Sacred encounters" in primary care: What do they mean for family physicians?

OBJETIVO: Conocer las percepciones y actitudes de profesionales médicos de familia (MF) ante consultas con gran componente emocional, denominadas inicialmente «consultas sagradas», e identificar ámbitos de mejora en su atención. DISEÑO: Metodología cualitativa con enfoque sociosubjetivo orientado a los servicios de salud. Estudio descriptivo-interpretativo. Emplazamiento: Centros de salud de Araba y Bizkaia. Participantes y/o contextos: Selección de 23 MF de 23 centros de salud urbanos y rurales. MÉTODO: Muestreo intencional buscando la diversidad discursiva. Datos generados en 2016 mediante 3 grupos de discusión y 3 entrevistas individuales grabadas y transcritas tras consentimiento informado. Presentación al Comité de Ética de Euskadi. Análisis temático con ayuda de mapas conceptuales y programa MaxQDA. Triangulación de los resultados entre investigadores y verificación por los participantes. Resultados y discusión: Los hallazgos se agruparon en áreas temáticas solapadas entre sí y relacionadas con el significado de dichas consultas, actitudes profesionales, contexto sanitario y pacientes. Se subraya la importancia de lo emocional en las consultas de atención primaria y su invisibilización, pero se cuestiona la idoneidad del término «sagradas». Su expresión se construye en la interrelación MF-paciente si el personal médico lo favorece y el paciente lo permite, discutiéndose las principales circunstancias que intervienen en una dimensión considerada clave de la integralidad de la atención. CONCLUSIONES: La atención a la dimensión emocional en la consulta presenta deficiencias que es necesario subsanar. Además de su reconocimiento y evaluación, sería preciso modificar los factores organizativos, formativos y profesionales que condicionan la implicación del personal MF en su buena asistencia

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. Participants Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. Results and discusión: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care

El género como determinante de la salud mental y su medicalización. Informe SESPAS 2020 / Gender as a determinant of mental health and its medicalization. SESPAS Report 2020

La peor salud mental de las mujeres ha sido demostrada tanto en encuestas de salud como en estudios de base clínica. La hipótesis acerca de una mayor vulnerabilidad biológica de las mujeres es inconsistente, lo que haría que las condiciones de vida desiguales entre hombres y mujeres, junto con los modelos imperantes de masculinidad y feminidad hegemónicos, puedan estar explicando estas desigualdades de género en la salud mental. El artículo muestra la existencia de desigualdades de género en la salud mental, la relevancia de la intersección de diferentes ejes de desigualdad y un posible proceso de sobrediagnóstico y medicalización de la salud mental de las mujeres, por el cual los/las profesionales de la salud están etiquetando con más frecuencia como depresión y ansiedad estados de salud mental similares en hombres y mujeres, y prescribiendo con mayor intensidad psicofármacos a las mujeres, a igualdad de necesidad. Esta realidad, además, parece ser desigual en función de la edad y del nivel socioeconómico de los/las pacientes. En los últimos años se están desarrollando diferentes experiencias dirigidas a afrontar la creciente medicalización de la salud mental desde una perspectiva de género. En la medida en que el fenómeno de las desigualdades de género es complejo, resulta necesario actuar y promover cambios en los sectores político-estructural, cultural y asistencial, que reviertan en su conjunto en la reducción de las desigualdades de género en las sociedades y en una atención sanitaria sin sesgos de género

Women's worse mental health has been shown using both health survey and clinical-based data. Considering that the hypothesis about a greater biological vulnerability of women is inconsistent, unequal living conditions between men and women, together with hegemonic models of hegemonic masculinity and femininity emerge as explain factors of these gender inequalities in mental health. The article shows that gender inequalities in mental health, the intersection of different axes of inequality, and the existence of a possible process of medicalization of women's mental health, by which health professionals are labeling women more frequently as depressed and anxious given similar mental health status in men and women. Prescription of psychotropic drugs is also of greater intensity in women, given equal need. This reality, moreover, seems to be unequal depending on the age and socioeconomic level of the patients. In recent years, different experiences are being developed aimed at addressing the growing medicalization of mental health from a gender perspective. Given that the phenomenon of medicalization is complex, it is necessary to act and promote changes at political-structural, cultural and health care levels that ultimately reverse gender inequalities in societies and promote non gender-biased healthcare

[]"Sacred encounters" in primary care: What do they mean for family physicians?] / «Consultas sagradas¼ en atención primaria: ¿qué suponen para el personal médico?

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. PARTICIPANTS: Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. RESULTS AND DISCUSSION: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care.

[Benzoletter: minimal intervention for deprescribing benzodiazepines in patients with insomnia]. / Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio.

OBJECTIVE: To determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption. METHOD: A before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated. RESULTS: Dispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89mg; 95%CI: 72.2-105.7). CONCLUSION: The Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness.