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18 pages, 1598 KiB

Open AccessArticle

Validation of the Spanish Version of the Double Knowledge Expectations and Received Knowledge Significant Other Scale for Informal Caregivers of People with Dementia (KESO-DEM/RKSO-DEM)

by Cindy E. Frías, Claudia Casafont, Esther Cabrera and Adelaida Zabalegui

Int. J. Environ. Res. Public Health 2022, 19(9), 5314; https://doi.org/10.3390/ijerph19095314 - 27 Apr 2022

Cited by 1 | Viewed by 1553

Abstract

Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received [...] Read more.

Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received knowledge for informal caregivers of people with dementia (KESO-DEM/RKSO-DEM), the analysis of the dimensional structure of the instrument, its validity and reliability, and temporary stability was carried out. An analysis of criterion and construct validity, internal consistency, and test–retest stability was performed. The evaluation of the interrelation between dimensions was statistically significant. Regarding internal consistency, the scale values were good both for the scale totals and for each dimension of knowledge, with Cronbach’s alpha coefficients of 0.97. For criterion validity, all items showed temporal stability for both questionnaires (p < 0.05). The availability of a valid, reliable tool for the measurement of expected and received knowledge in caregivers of people with dementia allows an approach based on the real needs of the family and the patient. It is important to design care protocols for people with dementia that are adapted to their needs and expectations and to their non-curative treatment, to improve the emotional well-being of patients and informal caregivers. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 889 KiB

Open AccessArticle

Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project

by Aina Perelló-Bratescu, Christian Dürsteler, Maria Asunción Álvarez-Carrera, Laura Granés, Belchin Kostov and Antoni Sisó-Almirall

Int. J. Environ. Res. Public Health 2022, 19(3), 1652; https://doi.org/10.3390/ijerph19031652 - 31 Jan 2022

Cited by 4 | Viewed by 3122

Abstract

The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of [...] Read more.

The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged ≥15 years with a continued SO prescription for ≥3 months during 2013–2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 714 KiB

Open AccessArticle

Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital

by Lesley Charles, Utkarsha Kothavade, Suzette Brémault-Phillips, Karenn Chan, Bonnie Dobbs, Peter George Jaminal Tian, Sharna Polard and Jasneet Parmar

Int. J. Environ. Res. Public Health 2022, 19(3), 1560; https://doi.org/10.3390/ijerph19031560 - 29 Jan 2022

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Abstract

BACKGROUND. With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we [...] Read more.

BACKGROUND. With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS. This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006–2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS. Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION. This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 1170 KiB

Open AccessArticle

Characteristics of Clinics without National Health Insurance Contracts: A Nationwide Survey in Taiwan

by Pei-Jyun Lu, Jui-Yao Liu, Hsin Ma, Tzeng-Ji Chen, Li-Fang Chou and Shinn-Jang Hwang

Int. J. Environ. Res. Public Health 2022, 19(3), 1517; https://doi.org/10.3390/ijerph19031517 - 28 Jan 2022

Cited by 3 | Viewed by 3236

Abstract

Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is [...] Read more.

Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is not universally accepted. This study used Taiwan as the backdrop to understand why many health clinics have chosen not to accept the National Health Insurance (NHI), despite it covering 99.93% of the country’s population. The clinics’ operational details were garnered from the datasets of Taiwan’s open government data platforms and checked against the list of contracting clinics within the NHI. Of 10,907 Western medicine primary care clinics in 2016, as many as 9846 (90.3%) clinics had signed contracts with the NHI. The remaining 1061 noncontracting clinics were distributed in urban (94.5%, n = 1003), suburban (4.9%, n = 52), and rural/remote areas (0.6%, n = 6). The NHI did not have contracts with 183 plastic surgery, 88 internal medicine, and 85 surgery clinics. In conclusion, nearly one-tenth of clinics practiced independently of the NHI in Taiwan. Their reasons for declining the contract and practices for delivering their services deserve further studies. Full article

(This article belongs to the Special Issue Primary Healthcare)

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19 pages, 1893 KiB

Open AccessArticle

Diabetes Capabilities for the Healthcare Workforce Identified via a 3-Staged Modified Delphi Technique

by Giuliana Murfet, Joan Ostaszkiewicz and Bodil Rasmussen

Int. J. Environ. Res. Public Health 2022, 19(2), 1012; https://doi.org/10.3390/ijerph19021012 - 17 Jan 2022

Cited by 2 | Viewed by 3955

Abstract

Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a [...] Read more.

Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60 [71%]), allied health (n = 17 [20%]), and pharmacy (n = 7 [9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability—259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research. Full article

(This article belongs to the Special Issue Primary Healthcare)

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14 pages, 617 KiB

Open AccessArticle

A Comprehensive Assessment of Informal Caregivers of Patients in a Primary Healthcare Home-Care Program

by Virginia Rodrigo-Baños, Marta del Moral-Pairada and Luis González-de Paz

Int. J. Environ. Res. Public Health 2021, 18(21), 11588; https://doi.org/10.3390/ijerph182111588 - 4 Nov 2021

Cited by 7 | Viewed by 3289

Abstract

Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed [...] Read more.

Studies of the characteristics of informal caregivers and associated factors have focused on care-receiver disease or caregiver social and psychological traits; however, an integral description may provide better understanding of informal caregivers’ problems. A multicenter cross-sectional study in primary healthcare centers was performed in Barcelona (Spain). Participants were a random sample of informal caregivers of patients in a home-care program. Primary outcomes were health-related quality of life and caregiver burden, and related factors were sociodemographic data, clinical and risk factors, social support and social characteristics, use of healthcare services, and care receivers’ status. In total, 104 informal caregivers were included (mean age 68.25 years); 81.73% were female, 54.81% were retired, 58.65% had high comorbidity, and 48.08% of care receivers had severe dependence. Adjusted multivariate regression models showed health-related quality of life and the caregivers’ burden were affected by comorbidity, age, time of care, and dependency of care receiver, while social support and depression also showed relative importance. Aging, chronic diseases, and comorbidity should be included when explaining informal caregivers’ health status and wellbeing. The effectiveness of interventions to support informal caregivers should comprehensively evaluate caregivers when designing programs, centering interventions on informal caregivers and not care receivers’ conditions. Full article

(This article belongs to the Special Issue Primary Healthcare)

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13 pages, 568 KiB

Open AccessArticle

Academic Promotion of Physicians in Medical Schools: A Special Focus on Primary Health Care in Taiwan

by Hsin Ma, Feng-Yuan Chu, Tzeng-Ji Chen and Shinn-Jang Hwang

Int. J. Environ. Res. Public Health 2021, 18(18), 9615; https://doi.org/10.3390/ijerph18189615 - 12 Sep 2021

Cited by 1 | Viewed by 2989

Abstract

The quality and quantity of papers published in journals play a crucial role in achieving an academic promotion in medical schools. Reports on the criteria for promotion and their impact on different specialties, especially on primary health care, which has low research output, [...] Read more.

The quality and quantity of papers published in journals play a crucial role in achieving an academic promotion in medical schools. Reports on the criteria for promotion and their impact on different specialties, especially on primary health care, which has low research output, are rare. We investigated the scoring systems generally adopted for academic promotion at most medical schools in Taiwan. The weighted scores were derived from the multiplication of weights from categories of paper, journal impact factor, or ranking in a certain category by impact factor, and author order. To determine the thresholds of papers required for different levels of promotion, we took papers in the highest- or lowest-ranked journals in the primary health care category in 2019 Journal Citation Reports as examples. Considering publications in the highest-ranked journals, a median of 4.6 first or corresponding author papers were required for a professorship, as well as 3.3 for an associate professorship, and 2.5 for an assistant professorship. In contrast, a median of 30, 20, and 13.5 papers in the lowest-ranked journals was required for the corresponding positions. Thus, academic promotions for primary health care educators in Taiwan are highly demanding. The detrimental effects of scoring systems deserve further research. Full article

(This article belongs to the Special Issue Primary Healthcare)

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22 pages, 1126 KiB

Open AccessArticle

Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

by Grant Stafford, Noemí Villén, Albert Roso-Llorach, Amelia Troncoso-Mariño, Mònica Monteagudo and Concepción Violán

Int. J. Environ. Res. Public Health 2021, 18(17), 9216; https://doi.org/10.3390/ijerph18179216 - 1 Sep 2021

Cited by 26 | Viewed by 4051

Abstract

(1) Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue [...] Read more.

(1) Background: The acquisition of multiple chronic diseases, known as multimorbidity, is common in the elderly population, and it is often treated with the simultaneous consumption of several prescription drugs, known as polypharmacy. These two concepts are inherently related and cause an undue burden on the individual. The aim of this study was to identify combined multimorbidity and polypharmacy patterns for the elderly population in Catalonia. (2) Methods: A cross-sectional study using electronic health records from 2012 was conducted. A mapping process was performed linking chronic disease categories to the drug categories indicated for their treatment. A soft clustering technique was then carried out on the final mapped categories. (3) Results: 916,619 individuals were included, with 93.1% meeting the authors’ criteria for multimorbidity and 49.9% for polypharmacy. A seven-cluster solution was identified: one non-specific (Cluster 1) and six specific, corresponding to diabetes (Cluster 2), neurological and musculoskeletal, female dominant (Clusters 3 and 4) and cardiovascular, cerebrovascular and renal diseases (Clusters 5 and 6), and multi-system diseases (Cluster 7). (4) Conclusions: This study utilized a mapping process combined with a soft clustering technique to determine combined patterns of multimorbidity and polypharmacy in the elderly population, identifying overrepresentation in six of the seven clusters with chronic disease and chronic disease-drug categories. These results could be applied to clinical practice guidelines in order to better attend to patient needs. This study can serve as the foundation for future longitudinal regarding relationships between multimorbidity and polypharmacy. Full article

(This article belongs to the Special Issue Primary Healthcare)

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12 pages, 2615 KiB

Open AccessArticle

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan

by Yueh-Hsin Wang, Hui-Chun Li, Kuang-Yu Liao, Tzeng-Ji Chen and Shinn-Jang Hwang

Int. J. Environ. Res. Public Health 2021, 18(17), 9097; https://doi.org/10.3390/ijerph18179097 - 28 Aug 2021

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Abstract

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study [...] Read more.

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments. Full article

(This article belongs to the Special Issue Primary Healthcare)

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21 pages, 1645 KiB

Open AccessArticle

Analysis of Patient Safety Incidents in Primary Care Reported in an Electronic Registry Application

by Montserrat Gens-Barberà, Núria Hernández-Vidal, Elisa Vidal-Esteve, Yolanda Mengíbar-García, Immaculada Hospital-Guardiola, Eva M. Oya-Girona, Ferran Bejarano-Romero, Carles Castro-Muniain, Eva M. Satué-Gracia, Cristina Rey-Reñones and Francisco M. Martín-Luján

Int. J. Environ. Res. Public Health 2021, 18(17), 8941; https://doi.org/10.3390/ijerph18178941 - 25 Aug 2021

Cited by 9 | Viewed by 3167

Abstract

Objectives: (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. Design: Descriptive analytical [...] Read more.

Objectives: (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. Design: Descriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service. Setting: 24 Catalan Institute of Health PC health centres of the Tarragona region (Spain). Participants: Professionals from the PC health centres and a Patient Safety Functional Unit. Measurements: Data obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions. Results: A total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%). Conclusions: PS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 882 KiB

Open AccessArticle

The Risk of Hospitalization in COVID-19 Patients Can Be Predicted by Lung Ultrasound in Primary Care

by Javier Martínez-Redondo, Carles Comas, Jesús Pujol Salud, Montserrat Crespo-Pons, Cristina García-Serrano, Marta Ortega Bravo and Jose María Palacín Peruga

Int. J. Environ. Res. Public Health 2021, 18(11), 6083; https://doi.org/10.3390/ijerph18116083 - 4 Jun 2021

Cited by 3 | Viewed by 3302

Abstract

Background: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. [...] Read more.

Background: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. Methods: This observational study collects data from a cohort of 279 patients with clinical symptoms of COVID-19 pneumonia who attended the Balaguer Primary Health Care Area between 16 March 2020 and 30 September 2020. We collected the results of LUS scans reported by one general practitioner. We created a database and analysed the absolute and relative frequencies of LUS findings and their association with hospital admission. We found that different LUS patterns (diffuse, attenuated diffuse, and predominantly unilateral) were risk factors for hospital admission (p < 0.05). Additionally, an evolutionary pattern during the acute phase represented a risk factor (p = 0.0019). On the contrary, a normal ultrasound pattern was a protective factor (p = 0.0037). Finally, the presence of focal interstitial pattern was not associated with hospital admission (p = 0.4918). Conclusion: The lung ultrasound was useful to predict complications in COVID-19 pneumonia and to diagnose other lung diseases such as cancer, tuberculosis, pulmonary embolism, chronic interstitial pneumopathy, pleuropericarditis, pneumonia or heart failure. Full article

(This article belongs to the Special Issue Primary Healthcare)

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14 pages, 1234 KiB

Open AccessArticle

Adjusting Client-Level Risks Impacts on Home Care Organization Ranking

by Aylin Wagner, René Schaffert and Julia Dratva

Int. J. Environ. Res. Public Health 2021, 18(11), 5502; https://doi.org/10.3390/ijerph18115502 - 21 May 2021

Viewed by 2442

Abstract

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives [...] Read more.

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 2910 KiB

Open AccessArticle

Missing Diagnoses during the COVID-19 Pandemic: A Year in Review

by Héctor Pifarré i Arolas, Josep Vidal-Alaball, Joan Gil, Francesc López, Catia Nicodemo and Marc Saez

Int. J. Environ. Res. Public Health 2021, 18(10), 5335; https://doi.org/10.3390/ijerph18105335 - 17 May 2021

Cited by 34 | Viewed by 5549

Abstract

The COVID-19 pandemic has had major impacts on population health not only through COVID-positive cases, but also via the disruption of healthcare services, which in turn has impacted the diagnosis and treatment of all other diseases during this time. We study changes in [...] Read more.

The COVID-19 pandemic has had major impacts on population health not only through COVID-positive cases, but also via the disruption of healthcare services, which in turn has impacted the diagnosis and treatment of all other diseases during this time. We study changes in all new registered diagnoses in ICD-10 groups during 2020 with respect to a 2019 baseline. We compare new diagnoses in 2019 and 2020 based on administrative records of the public primary health system in Central Catalonia, Spain, which cover over 400,000 patients and 3 million patient visits. We study the ratio of new diagnoses between 2019 and 2020 and find an average decline of 31.1% in new diagnoses, with substantial drops in April (61.1%), May (55.6%), and November (52%). Neoplasms experience the largest decline (49.7%), with heterogeneity in the magnitudes of the declines across different types of cancer diagnoses. While we find evidence of temporal variation in new diagnoses, reductions in diagnoses early in the year are not recouped by the year end. The observed decline in new diagnoses across all diagnosis groups suggest a large number of untreated and undetected cases across conditions. Our findings provide a year-end summary of the impact of the pandemic on healthcare activities and can help guide health authorities to design evidence-based plans to target under-diagnosed conditions in 2021. Full article

(This article belongs to the Special Issue Primary Healthcare)

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13 pages, 1162 KiB

Open AccessArticle

Self-Perception and Self-Acceptance Are Related to Unhealthy Weight Control Behaviors in Catalan Adolescents: A Cross-Sectional Study

by Mercè Pollina-Pocallet, Eva Artigues-Barberà, Glòria Tort-Nasarre, Joaquim Sol, Laura Azlor, Quintí Foguet-Boreu and Marta Ortega-Bravo

Int. J. Environ. Res. Public Health 2021, 18(9), 4976; https://doi.org/10.3390/ijerph18094976 - 7 May 2021

Cited by 10 | Viewed by 3834

Abstract

Adolescence is associated with a higher vulnerability that may result in a high dissatisfaction, the practice of unhealthy weight-control behaviors (UWCB) and, eventually, the onset of body image-related mental disorders. These factors are strongly associated with the social context, so it is important [...] Read more.

Adolescence is associated with a higher vulnerability that may result in a high dissatisfaction, the practice of unhealthy weight-control behaviors (UWCB) and, eventually, the onset of body image-related mental disorders. These factors are strongly associated with the social context, so it is important to characterize them in local or regional studies. To assess the relationship between body image and UWCB presence, a cross-sectional study was performed among 2496 schooled adolescents from Lleida (Spain) between 2017 and 2019. Their perceived and desired images were evaluated and compared with the real image in order to obtain the body distortion and the body dissatisfaction and relate them with UWCB. The studied individuals perceived themselves thinner than they actually were, with no differences between males and females. However, differences were found regarding body dissatisfaction, showing that females desired to be thinner, while males desired a more corpulent body image. Furthermore, one out of ten individuals reported UWCB, with higher prevalence among females. UWCB was associated with a desire to be thinner and with distorted body images. It is essential to work on self-perception and self-acceptance in early adolescence from an interdisciplinary perspective at educational, social and health levels to promote health in adolescence. Full article

(This article belongs to the Special Issue Primary Healthcare)

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10 pages, 478 KiB

Open AccessArticle

Effectiveness of an Intervention Aimed at Improving Information for Patients with High Cardiovascular Risk: INFORISK Clinical Trial

by Carlos Brotons, Irene Moral, Diana Fernández, Mireia Puig, M. Teresa Vilella, Teresa Puig, LLuís Cuixart, Gemma Férriz, Anna M. Pedro, Roger Codinachs, Mónica Rodríguez, Rubén Fuentes and on behalf of INFORISK Study Investigators

Int. J. Environ. Res. Public Health 2021, 18(7), 3621; https://doi.org/10.3390/ijerph18073621 - 31 Mar 2021

Cited by 4 | Viewed by 2425

Abstract

Background: The concept of global cardiovascular risk is not usually well understood by patients in consultation. Methods: This was a multicenter, prospective, randomized, open clinical trial of one-year duration to evaluate the effectiveness in reducing global cardiovascular risk with an intervention aimed at [...] Read more.

Background: The concept of global cardiovascular risk is not usually well understood by patients in consultation. Methods: This was a multicenter, prospective, randomized, open clinical trial of one-year duration to evaluate the effectiveness in reducing global cardiovascular risk with an intervention aimed at high-risk patients to improve information on the cardiovascular risk compared to the usual care. The intervention was focused on providing information about cardiovascular risk in a more understandable way, explaining the best practices to reduce cardiovascular risk, and tailoring information to the individual. Results: Four-hundred and sixty-four subjects participated in the study; 59.3% were men, and the mean age was 61.0 (SD 8.0) years. Significant reductions in systolic blood pressure (SBP) (−3.12 mmHg), body mass index (BMI) (−0.34 kg/m²), abdominal circumference (−1.24 cm), and REGICOR cardiovascular risk (−0.63) were observed in the intervention group. Overall, no differences in cardiovascular risk score were observed between groups at the end of follow-up. Conclusions: Providing an easy-to-understand assessment of the cardiovascular risk motivated high-risk patients to adopt a healthier lifestyle and improved cardiovascular risk after one year in the intervention group. Clinicians should assess a patient’s baseline understanding of their CV risk using tools other than absolute risk before making treatment recommendations. Full article

(This article belongs to the Special Issue Primary Healthcare)

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18 pages, 2421 KiB

Open AccessArticle

The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study

by Ping-Jen Chen, Chung-Han Ho, Jung-Yu Liao, Lisanne Smits, Chao A. Hsiung, Sang-Ju Yu, Kai-Ping Zhang, Irene Petersen and Elizabeth L. Sampson

Int. J. Environ. Res. Public Health 2020, 17(24), 9255; https://doi.org/10.3390/ijerph17249255 - 10 Dec 2020

Cited by 9 | Viewed by 4213

Abstract

Background: For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing [...] Read more.

Background: For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing the end-of-life for people with dementia at a national level. Methods: A nested case-control analysis was applied in a retrospective cohort study using a nationwide electronic records database. We included people with new dementia diagnoses who died during 2002–2013 in whole population data from the universal healthcare system in Taiwan. Burdensome transitions were defined as multiple hospitalisations in the last 90 days (early transitions, ET) or any hospitalisation or emergency room visit in the last three days of life (late transitions, LT). People with (cases) and without (controls) burdensome transitions were matched on a ratio of 1:2. We performed conditional logistic regression with stratified analyses to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) of the risks of transitions. Results: Among 150,125 people with new dementia diagnoses, 61,399 died during follow-up, and 31.1% had burdensome transitions (50% were early and 50% late). People with ET had the highest frequency of admissions and longer stays in hospital/ICU during their last year of life, while people with LT had fewer hospital/ICU utilisation than people without end-of-life transitions. Receiving HHC was associated with an increased risk of ET (OR = 1.14, 95 % CI: 1.08–1.21) but a decreased risk of LT (OR = 0.89, 95 % CI 0.83–0.94). In the people receiving HHC, however, those who received longer duration (e.g., OR = 0.50, 95 % CI: 0.42–0.60, >365 versus ≤30 days) or more frequent HHC or HHC delivered closer to the time of death were associated with a remarkably lower risk of ET. Conclusions: HHC has differential effects on early and late transitions. Characteristics of HHC such as better continuity or interdisciplinary coordination may reduce the risk of transitions at the end-of-life. We need further studies to understand the longitudinal effects of HHC and its synergy with palliative care, as well as the key components of HHC that achieve better end-of-life outcomes. Full article

(This article belongs to the Special Issue Primary Healthcare)

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Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

by Antoni Sisó-Almirall, Pilar Brito-Zerón, Laura Conangla Ferrín, Belchin Kostov, Anna Moragas Moreno, Jordi Mestres, Jaume Sellarès, Gisela Galindo, Ramon Morera, Josep Basora, Antoni Trilla, Manuel Ramos-Casals and on behalf of the CAMFiC long COVID-19 Study Group

Int. J. Environ. Res. Public Health 2021, 18(8), 4350; https://doi.org/10.3390/ijerph18084350 - 20 Apr 2021

Cited by 129 | Viewed by 23827

Abstract

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main [...] Read more.

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups. Full article

(This article belongs to the Special Issue Primary Healthcare)

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