[Community reorientation of primary care in a health area: ROCAP project]. / Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP.

AIM: Evaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DESIGN: During January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PLACE: The scope is the 11 ZBS of a health area. PARTICIPANTS: The study population is the ZBS and the respective teams represented by the medical and nursing coordinations. INTERVENTIONS: Promote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. MAIN MEASUREMENTS: Quantitative and qualitative analysis was carried out pre and post after the first year of intervention. RESULTS: In the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. CONCLUSIONS: The intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

[Digital literacy as a key element in the digital transformation of health organizations]. / La alfabetización digital como elemento clave en la transformación digital de las organizaciones en salud.

In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.

[Barriers and facilitators in accessing and using primary health care centers for people experiencing homelessness]. / Barreras y facilitadores en el acceso y la utilización de los centros de atención primaria para las personas en situación de sinhogarismo.

OBJECTIVE: To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness. DESIGN: Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023. LOCATION: Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona). PARTICIPANTS: People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center. METHOD: Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques. RESULTS: Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1)concept and identification of people experiencing homelessness; (2)personal factors of people experiencing homelessness; (3)behaviors and attitudes of professionals; (4)structural factors related to health system regulation, anf (5)internal organizational factors of primary health care centers. CONCLUSIONS: People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.

[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

[The influence of the institutions on local health councils]. / La influencia de las instituciones en los consejos locales de salud.

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. / Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19.

OBJECTIVE: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS: MC Nemar's test to compare the main variables between the study periods. RESULTS: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

Practices and knowledge of health personnel about transgenderity in Primary Health Care.

OBJECTIVE: To describe the practices and knowledge of Nursing Technicians and Community Health Agents of Primary Health Care for the transgender population. DESIGN: Descriptive research with a qualitative approach. SITE: The study was developed in a digital environment. PARTICIPANTS: 18 Community Health Agents and 12 Nursing Technicians who worked in Primary Health Care Units from several Brazilian states. METHOD: Sampling technique by chain indication or networks (snowball), data production by Google Forms form. The theoretical saturation technique was used to close the interviews. Categorical thematic content analysis with IRAMUTEQ software support. RESULTS: Professionals' lack of knowledge about policies and terms was evidenced; there were conceptual confusions, inadequate associations, and a restricted approach to the prevention of sexually transmitted infections. CONCLUSIONS: The lack of training reflects a cisnormative and binary approach, compromising the assistance to the transgender population. Disrespect for the social name persists, highlighting the need for permanent education for health professionals, aiming at an inclusive and respectful care practice.

[Health and social care in an urban nursing home providing healthcare services and primary care's role: A qualitative study with residents, relatives and professionals]. / Atención sociosanitaria en una residencia urbana sanitarizada y el papel de Atención Primaria. Estudio cualitativo con residentes, familiares y profesionales.

AIM: To identify the elements involved in adequate health and social care for old people living in nursing homes, determine their possible barriers and enablers and define primary care's role in it. DESIGN: Qualitative study with phenomenological approach. SETTING: State funded private nursing home and its corresponding primary care center in the southeastern urban area of Madrid. PARTICIPANTS: Elderly residents, their relatives, and professionals from the nursing home and the primary care center. METHOD: Five focus groups were conducted between November 2019 and January 2020, with semi-structured interviews based on the variables of analysis and themes related to the objectives. The sessions were recorded and transcribed. An open and axial coding was performed to identify categories after a triangulation of the data. RESULTS: The elements of adequate care identified are individualized care, promotion of autonomy, adequate information to residents and relatives, quality of services, coordination between professionals, and a continuous end of life care. The main barriers are the deficit of professionals, the differences in expectations between users and workers, and the organizational gap between the healthcare system and nursing homes providing healthcare services. The role identified for primary care is mostly bureaucratic. CONCLUSIONS: It is necessary to continue exploring these elements and to outline the role of primary care in nursing homes with different characteristics.

[Knowledge, use and opinion about written informed consent in primary healthcare nurses: CONOSER pilot project]. / Conocimiento, implementación y opinión acerca del consentimiento informado por escrito de las enfermeras de atención primaria: proyecto piloto CONOSER.

OBJECTIVE: To know the knowledge, implementation and opinion on informed consent of generalist nurses, specialists and primary care residents. DESIGN: Descriptive cross-sectional study using an online self-administered 'ad hoc' questionnaire. SETTING: Primary care nurses in Madrid, from November 2020 to March 2021. PARTICIPANTS: Sample of 114 nurses: 91 generalist, 20 specialists and 3 residents. MAIN MEASUREMENTS: Sociodemographics, knowledge, implementation and opinion. RESULTS: The response rate was 27.7%. As a general rule, 48.2% indicated that informed consent was collected verbally, as established by law, with differences being found between categories, this percentage being higher in specialists and residents (P=0.004), and within specialists in those who had obtained their speciality by internal resident nurse (IRN) (P<0.0001). In addition, specialists and residents were those who most identified the legal norm regulating informed consent (P<0.0001). In terms of implementation and opinion, all groups obtained similar results. DISCUSSION: There are no previous studies that have analysed these aspects of informed consent comparing the different categories. Studies from other healthcare and geographical areas show that nurses have greater knowledge, although the demand for specific training in bioethics and biolaw is greater in the nurses participating in this study. CONCLUSIONS: Nurses have adequate knowledge about informed consent, use it in clinical practice and have an appropriate conception of it, being higher in some items in specialist nurses IRN and in residents.

[COVID-19 pandemic impact on primary care emergency services activity: Comparative study between 2019 and 2020 periods]. / Impacto de la pandemia de la COVID-19 en la actividad de los servicios de urgencias de atención primaria: estudio comparativo entre periodos de 2019 y 2020.

OBJECTIVE: To compare the care provided by primary care emergency services during the COVID19 lockdown (March-June 2020) and the same period in 2019. DESIGN: Retrospective descriptive study. SETTING: Basic Health Area of Granada. POPULATION: 10.790 emergency reports, 3.319 in 2020 and 7.471 in 2019. OUTCOMES: Age, sex, service, shifts, referrals, priority levels, care times, previous processes, and reasons for consultation. T-Student and Chi Square were used for continuous and categorical variables. Effect size (Cohen's d) and OR along with 95% CI were calculated. RESULTS: The patients attended by primary care emergency services decreased in 2020 compared to 2019, but the percentage of Priority V cases (p<0.01), home discharges (p=0.01) and hospital transfers (p<0.01) increased, and referrals to family doctors (p<0.01) decreased. In 2020, the percentage of emergencies at night (p<0.01) and in low-income neighborhoods (p<0.01) increased. Waiting time for classification decreased (p<0.01), but total care time increased in 2020 (p<0.01). The patients seen in 2020 were older (p<.001), and with a greater number of previous processes (p<0.01), highlighting patients with anxiety, depression, or somatization (p<0.01) and diabetes (p=0.041). Consultations related to various symptoms of COVID19, mental health problems and chronic pathologies increased. CONCLUSIONS: Primary care emergency services offer additional advantages in situations such as the COVID19 pandemic, as they allow channeling part of the health demand.

[Multicomponent treatment of tobacco in primary care: Follow-up over 5years]. / Tratamiento multicomponente del tabaquismo en Atención Primaria: seguimiento transcurridos más de 5 años.

OBJECTIVES: To analyze the effectiveness of a multicomponent treatment for smoking cessation carried out in primary care and to evaluate the evolution of the consumption of tobacco that the people who participated had, more than 5 years after the end of the treatment. DESIGN: Longitudinal study of 307 participants in a multicomponent program in group format of tobacco cessation. EMPLACEMENT: Santander (Spain) Primary Care Health Center. PARTICIPANTS: Smokers from the basic health zone who wanted to quit smoking between 2006 and 2012 and requested help. INTERVENTIONS: Multicomponent treatment of 5face-to-face sessions and follow-up for up to 12 months. PRIMARY MEASUREMENTS: The activity was evaluated in 263 participants more than 5years after the end of treatment. The results of continuous and punctual withdrawal were obtained by self-declaration and the data recorded in the medical record. The punctual was also validated with co-oximetry. RESULTS: After a year 42.7% of participants declared continuous abstinence. From 5 to 12 years later, the continuous declared abstinence further than 12 months was 40.7%. They did not smoke again since the end of the treatment 66 people; 68.0% of those who relapsed made new attempts and 45.5% of them requested help to quit smoking. CONCLUSIONS: The proposed multi-component treatment is effective. Abstinence at 12 months predicts long-term maintenance and participating in disabling groups favors further attempts in case of relapse and the request for help to quit smoking.

[Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres]. / Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres.

OBJECTIVE: Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. DESIGN: Observational study. SITE: Urban Health Center in Cáceres. MAIN MEASUREMENTS: We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). RESULTS: 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it "adequate". 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. CONCLUSION: We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.

[Design and validation of the ACPAPS questionnaire to assess person-centred care by the family doctor]. / Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia.

OBJECTIVES: Design, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. DESIGN: Qualitative. Questionnaire design. LOCATION: Primary care. PARTICIPANTS: Two hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). METHODS: Construction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. RESULTS: The final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. CONCLUSIONS: The ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.

[Factors associated with an unfavorable evolution in patients diagnosed with COVID-19 and followed up in primary care in 2020]. / Factores asociados con una evolución desfavorable en pacientes diagnosticados de COVID-19 y seguidos en atención primaria en 2020.

AIM: To know the factors associated with an unfavorable evolution (UE) of patients diagnosed with COVID-19 with total or partial follow-up in primary care. DESIGN: A case series. SETTING: Urban health center. PARTICIPANTS: By systematic sampling, patients ≥18 years, diagnosed with COVID-19, with analytical confirmation, in 2020 and followed up by their family doctors, were selected. MAIN MEASUREMENTS: Dependent variable: hospital admission or death due to COVID-19. INDEPENDENT VARIABLES: age, sex, medical background, clinical data and treatments related to the disease. Statistical analysis, with SPSS 25.0: descriptive analysis, comparison of proportions (chi square) and medians (Mann-Whitney U). The analysis is completed with logistic regression. RESULTS: 610 patients were included in the study. The median age was 49 years (interquartile range: 35-61); 51.8% were women; 14.9% presented UE (95% CI: 12.0-17.8). The sociodemographic variables or the variables related to medical background that showed an independent association with UE were age (OR: 1.066; 95% CI: 1.038-1.095), sex (OR for men: 3.277; 95% CI: 1.304-8.235) and being a smoker or former smoker (OR: 2.565; 95% CI: 1.135-5.800). Regarding the clinical variables of the disease, an association was found for altered consciousness (OR: 62.829; 95% CI: 9.177-430.149), dyspnea (OR: 14.339; 95% CI: 6.046-34.009), expectoration (OR: 4.764; 95% CI: 1.858-12.213)) and asthenia (OR: 3.993; 95% CI: 1.705-9.351). CONCLUSIONS: 14.9% of the patients diagnosed with COVID-19 presented an UE. Older age, male sex and being a smoker or former smoker increased the probability of it. Altered consciousness, dyspnea, expectoration, and asthenia were the clinical data that best predicted UE.

[Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona]. / Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona.

Objetive To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. MAIN MEASUREMENTS: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. RESULTS: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. CONCLUSIONS: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.

[Adaptation and validation of an instrument to evaluate the competence on a Brief Tobacco Intervention. BTI-Prof©]. / Adaptación y validación de un instrumento de evaluación de la competencia del consejo breve para dejar de fumar. BTI-Prof©.

OBJECTIVE: Adaptation and validation of the BTI-St© to assess the level of competence in brief tobacco intervention in general practitioners and nurses in Primary Health Care. DESIGN: Cross-sectional study of adaptation and psychometric validation of a criterion-referenced test. SETTING: Primary Health Care. PARTICIPANTS: One hundred fifty-five general practitioners and nurses working at Primary Health Care. INTERVENTIONS: Three clinical scenarios were designed. Using an online platform, participants first viewed each scenario in which brief tobacco intervention was given. Health professional had to assess whether or not the scenarios were carried out in accordance with the 5A+5R model. MAIN MEASURES: Competence in brief tobacco intervention measured by the BTI-Prof©. RESULTS: Results related to reliability were obtained through Kuder-Richardson coefficient, being for scenario 1, 0.880, for scenario 2, 0.829, and for scenario 3, 0.826. The test-retest shows adequate temporal stability: intraclass correlation coefficient for scenario 1 0.857 (95% CI 0.734-0.923), p<0.0001, for scenario 2 0.829 (95% CI 0.676-0.909), p<0.001, and for scenario 3 0.869 (95% CI 0.76-0.928), p<0.0001. CONCLUSIONS: The BTI-Prof© is a robust tool with adequate psychometric properties to assess competence in brief tobacco intervention in Primary Health Care general practitioners and nurses.

[Validation of a questionnaire that measures perceptions of the role of community nursing professionals in Peru]. / Validación de un cuestionario que mide las percepciones del rol del profesional de enfermería comunitaria en Perú.

OBJECTIVE: To develop a valid and reliable scale to measure the role of the nursing professional in the community (REFCO). DESIGN: Observational with cross-sectional and instrumental design. SITE: Populated centers and communities of the coast, highlands and jungle from Peru. PARTICIPANTS: The validation phase of the questionnaire had the voluntary participation of 402 Peruvian adults (50.7% from the coast, 40.5% from the highlands and 8.8% from the jungle). INTERVENTIONS: The elaborated questionnaire that measures perceptions about the role of the nursing professional in the community was applied. MAIN MEASUREMENTS: The psychometric properties of the REFCO scale were analyzed, such as content validation and internal consistency through the calculation of Aiken's V, exploratory factor analysis (EFA) and later confirmatory factor analysis (CFA), respectively. Finally, the reliability of the scale was calculated. RESULTS: Overall, all values were statistically significant when evaluated with the V-Aiken coefficient. Likewise, the skewness and kurtosis values of all the items of the instrument did not exceed the range >±1.5. The correlations between factors 1 and 2 were significant (p < .05). The reliability of the scale presents a Cronbach's α coefficient = 0.865. CONCLUSIONS: The REFCO scale has 9 items and 2 dimensions; outreach and education; with content and construct validity that provide evidence for community nursing categories, which is useful for measuring nursing work in the community field.

[Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care]. / Condicionantes para el abordaje del aislamiento social y la soledad de adultos mayores no institucionalizados desde atención primaria de salud.

OBJECTIVE: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness. DESIGN: Qualitative research with grounded theory, systematic analysis and narrative design of topics. LOCATION: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas. PARTICIPANTS: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness. METHOD: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews. RESULTS: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals. CONCLUSIONS: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.

[Influence of the companion in Primary Care consultations on communication skills and interview time]. / Influencia del acompañante en las consultas de Atención Primaria sobre las habilidades en comunicación y el tiempo de entrevista.

OBJETIVES: To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. DESIGN: Cross-sectional descriptive study. LOCATION: 10 Primary Care Centers. PARTICIPANTS: Resident doctors of Family and Community Medicine. INTERVENTIONS: Peer review of video recordings of clinical demand consultations. MAIN MEASUREMENTS: CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. RESULTS: 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]). CONCLUSIONS: Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

[Pharmacological treatment of the heart failure according to the ventricular ejection fraction in primary care]. / Tratamiento farmacológico de la insuficiencia cardíaca según la fracción de eyección ventricular en atención primaria.

Despite better diagnoses and treatments, heart failure (HF) is an important cause of death in Spain. The objective of this study is to describe the characteristics and treatment of a population with chronic HF classified according to the left ventricular ejection fraction (LVEF). Population-based observational cohort study in Primary Health Care. Catalonia, Spain, during 2014-2018. Adults with HF classified by the LVEF. Analysis of electronic health data registered in SIDIAP (Information System for Research in Primary Care). Demographics, LVEF, comorbidities, and use of drugs for HF. 10,130 patients were included; 18.9% with LVEF<40 (HFrEF), 15.9% with LVEF 40-49 (HFmEF) and 65.2% with LVEF≥50 (HFpEF), this last group with a higher proportion of women (57.5%) and higher mean age (80.2 years-old). People with HFmEF were similar to those with HFrEF in age, gender, comorbidities and treatment. The most frequent comorbidities were hypertension (78.3%), dyslipidaemia (54%) and atrial fibrillation (41.5%). The most frequent pharmacological treatments were ß blockers with differences according to the LVEF [HFrEF 1515 (79.2%), HFmEF 1142 (70.8%) and HFpEF 3371 (51%)], followed by loop diuretics (65.7%). HF is a prevalent disease. Having information on LVEF could guide its pharmacological management. The HF population has persistent cardiovascular risk factors and habits. Treatment and population characteristics of patients with HFmEF are similar to those with HFrEF.