scholarly journals Low-value clinical practices and harm caused by non-adherence to ‘do not do’ recommendations in primary care in Spain: a Delphi study

2018 ◽  
Vol 31 (7) ◽  
pp. 519-526 ◽  
Author(s):  
José Joaquín Mira ◽  
Johanna Caro Mendivelso ◽  
Irene Carrillo ◽  
Javier González de Dios ◽  
Guadalupe Olivera ◽  
...  
Keyword(s):  
Primary Care ◽  
Delphi Study ◽  
Response Rate ◽  
National Health System ◽  
Care Quality ◽  
Pediatric Nurses ◽  
Clinical Practices ◽  
Spanish National Health System ◽  
The Impact ◽  
Selection Of

Abstract Objective To determine the non-adherence to the primary care ‘do not do’ recommendations (DNDs) and their likelihood to cause harm. Design Delphi study. Setting Spanish National Health System. Participants A total of 128 professionals were recruited (50 general practitioners [GPs], 28 pediatricians [PEDs], 31 nurses who care for adult patients [RNs] and 19 pediatric nurses [PNs]). Interventions A selection of 27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs were included in the Delphi technique. A 10-point scale was used to assess whether a given practice was still present and the likelihood of it causing of an adverse event. Main outcome measure Impact calculated by multiplying an event’s frequency and likelihood to cause harm. Results A total of 100 professionals responded to wave 1 (78% response rate) and 97 of them to wave 2 (97% response rate). In all, 22% (6/27) of the practices for GPs, 12% (1/8) for PEDs, 33% (3/9) for RNs and none for PNs were cataloged as frequent. A total of 37% (10/27) of these practices for GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36 points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or delirium in elderly patients (mean = 57.8, SD = 25.3). Conclusions Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.

P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Anguita ◽  
A Sambola Ayala ◽  
J Elola ◽  
J L Bernal ◽  
C Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
National Health System ◽  
Anterior Myocardial Infarction ◽  
Female Sex ◽  
Spanish National Health System ◽  
History Of ◽  
The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

scholarly journals Development and validation of the Vietnamese Primary Care Assessment Tool – provider version

2019 ◽  
Vol 20 ◽  
Author(s):  
Nguyen Thi Hoa ◽  
Anselme Derese ◽  
Jeffrey F. Markuns ◽  
Nguyen Minha Tam ◽  
Wim Peersman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Internal Consistency ◽  
Assessment Tool ◽  
Care Quality ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
The Impact ◽  
Primary Care Assessment Tool

Abstract Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

The Impact of Primary Care Dual-Management on Quality of Care

2011 ◽  
Vol 3 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Peter J. Kaboli ◽  
Daniel M. Shivapour ◽  
Michael S. Henderson ◽  
Areef Ishani ◽  
Mary E. Charlton
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Hemoglobin A1c ◽  
Ldl Cholesterol ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Providers ◽  
Dual Management ◽  
The Impact

Background: Discontinuity is common in US healthcare. Patients access multiple systems of care and in the nation’s largest integrated healthcare system, Veteran’s Administration (VA) patients frequently use non-VA primary care providers. The impact of this “dual-management” on quality is unknown. The authors’ objective was to identify dual-management and associations with markers of care quality for hypertension and associated conditions. Methods: Data was collected via surveys and chart reviews of primary care patients with hypertension from six VA clinics in Iowa and Minnesota. Clinical measures abstracted included the following: goal blood pressure (BP) and use of guideline-concordant therapy, low-density lipoprotein (LDL) cholesterol, hemoglobin A1C, and body mass index (BMI). Dual-management data was obtained through self-report. Results: Of 189 subjects (mean age = 66), 36% were dual-managed by non-VA providers. There was no difference in hypertension quality of care measures by dual-management status. A total of 51% were at BP goal and 58% were on guideline-concordant therapy. Dual-managed patients were more likely to use thiazide diuretics (43% vs 29%; P = .03) and angiotensin receptor blockers (13% vs 3%; P < .01), but less likely to use angiotensin-converting enzyme inhibitors (43% vs 61%; P = .02). There was no difference in LDL cholesterol (97.1 mg/dl vs 100.1 mg/dl; P = .55), hemoglobin A1C (7% vs 6%; P = .74), or BMI (29.8 vs 30.9; P = .40) for dual-managed versus VA managed patients, respectively. Conclusions: Although dual-management may decrease continuity, VA/private sector dual-management did not impact quality of care, though some medication differences were observed. With the high prevalence of dual-management, future work should further address quality and evaluate redundancy of services.

scholarly journals US Primary Care in 2029: A Delphi Survey on the Impact of Machine Learning

2020 ◽  
Author(s):  
Charlotte Blease ◽  
Anna Kharko ◽  
Cosima Locher ◽  
Catherine M. DesRoches ◽  
Kenneth D. Mandl
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Digital Health ◽  
Training Requirements ◽  
Modified Delphi ◽  
Primary Care Workforce ◽  
The Us ◽  
The Impact

AbstractObjectiveTo solicit leading health informaticians’ predictions about the impact of AI/ML on primary care in the US in 2029.DesignA three-round online modified Delphi poll.ParticipantsTwenty-nine leading health informaticians.MethodsIn September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed.ResultsA total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge.ConclusionsThis study presents timely information on informaticians’ consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.

scholarly journals The impact of Covid-19 on Belgian mental health care: A Delphi study among psychosocial health professionals, patients, and informal caretakers

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nele Van den Cruyce ◽  
Elke Van Hoof ◽  
Lode Godderis ◽  
Sylvie Gerard ◽  
Frédérique Van Leuven
Keyword(s):  
Delphi Study ◽  
Public Discourse ◽  
Social Inequalities ◽  
Response Rate ◽  
Negative Impact ◽  
Psychosocial Care ◽  
Psychosocial Health ◽  
Mental Strain ◽  
The Impact ◽  
Care System

AbstractThe Covid-19 pandemic is primarily viewed as a threat to physical health, and therefore, biomedical sciences have become an integral part of the public discourse guiding policy decisions. Nonetheless, the pandemic and the measures implemented have an impact on the population’s psychosocial health. The impact of Covid-19 on the psychosocial care system should be thoroughly investigated to mitigate this effect. In this context, the present study was conducted to establish a consensus about the impact of Covid-19 on psychosocial health and the care system in Belgium. Using the Belgian Superior Health Council’s expert database, a three-round Delphi consensus development process was organized with psychosocial experts (i.e., professionals, patients, and informal caregiver representatives). Overall, 113 of the 148 experts who participated in round 1 fully completed round 2 (76% response rate). Consensus (defined as >70% agreement and an interquartile interval (IQR) of no more than 2) was reached in round 2 for all but three statements. Fifty experts responded to round 3 by providing some final nuances, but none of them reaffirmed their positions or added new points to the discussion (44.25% response rate). The most robust agreement (>80%) was found for three statements: the pandemic has increased social inequalities in society, which increase the risk of long-term psychosocial problems; the fear of contamination creates a constant mental strain on the population, wearing people out; and there is a lack of strategic vision about psychosocial care and an underestimation of the importance of psychosocial health in society. Our findings show that experts believe the psychosocial impact of Covid-19 is underappreciated, which has a negative impact on psychosocial care in Belgium. Several unmet needs were identified, but so were helpful resources and barriers. The Delphi study’s overarching conclusion is that the pandemic does not affect society as a whole in the same way or with the same intensity. The experts, thereby, warn that the psychosocial inequalities in society are on the rise.

scholarly journals Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Amaia Calderón-Larrañaga ◽  
Luis A Gimeno-Feliu ◽  
Rosa Macipe-Costa ◽  
Beatriz Poblador-Plou ◽  
Daniel Bordonaba-Bosque ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
Immigrant Population ◽  
Spanish National Health System ◽  
Care Utilisation

scholarly journals Anesthesia departments’ readiness for the COVID-19 pandemic; a nationwide cross-sectional study in Israel

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Barak Cohen ◽  
Yuval Baar ◽  
Shai Fein ◽  
Idit Matot
Keyword(s):  
New Technologies ◽  
Response Rate ◽  
Department Chairs ◽  
Rapid Sequence Induction ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Clinical Practices ◽  
Research Activity ◽  
Cross Sectional ◽  
The Impact

Abstract Background The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements’ focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. The impact on anesthesiologists’ health, workload, and clinical practices were also evaluated. Methods An online questionnaire was distributed to all of anesthesia department chairs in Israel on April 14th. Each response was identifiable on the hospital level only. Informed consent was waived since no patient data were collected. Results Response rate was 100%. A decrease of at least 40% in operating-room activity was reported by two-thirds of the departments. Anesthesiologists are leading the treatment of COVID-19 patients in 19/28 (68%) Israeli hospitals. Israel Society of Anesthesiologists’ recommendations regarding intubation of COVID-19 patients were strictly followed (intubations performed by the most experienced available physician, by rapid-sequence induction utilizing video-laryngoscopy, while minimizing the number of people in the room - about 90% compliance for each). Anesthesiologists in most departments use standard personal protective equipment when caring for COVID-19 patients, including N95 masks, face shields, and water-proof gowns. Only one anesthesiologist across Israel was diagnosed with COVID-19 (unknown source of transmission). All department chairs reported emerging opportunities that advance the anesthesia profession: implementation of new technologies and improvement in caregivers’ clinical capabilities (68% each), purchase of new equipment (96%), and increase in research activity (36%). Conclusions This nationwide cross-sectional study had a complete response rate and therefore well-represents the anesthesia practice in Israel. We found that Israeli anesthesia departments are generally highly involved in the health system efforts to cope with the COVID-19 pandemic. Anesthesia and airway management are performed in a remarkably comparable manner and with proper protection of caregivers. Ambulatory anesthesia activity has dramatically decreased, but many departments find opportunities for improvement even in these challenging times.

Surveillance of cancer survivors: Results from a survey of primary care physicians working in the Spanish National Health System.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21562-e21562
Author(s):  
Begoña Graña ◽  
Ana Martinez ◽  
Manuel Lado ◽  
Maria Forjan ◽  
Rosario Garcia Campelo ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Health System ◽  
National Health ◽  
Primary Care Physicians ◽  
National Health System ◽  
Spanish National Health System

scholarly journals Impact of remdesivir for the treatment of COVID-19 during the first wave in Spain

2021 ◽  
Author(s):  
Alejandro Soriano ◽  
Rocío Montejano ◽  
José Sanz Moreno ◽  
Juan Carlos Figueira ◽  
Santiago Grau ◽  
...  
Keyword(s):  
National Health System ◽  
Real Life ◽  
Clinical Results ◽  
Supplemental Oxygen ◽  
Bed Occupancy ◽  
Spanish National Health System ◽  
Wave Methods ◽  
General Wards ◽  
Occupancy Rates ◽  
The Impact

Abstract Background: Spain was one of the most affected countries during the first wave of COVID-19, having the highest mortality rate in Europe. The aim of this retrospective study is to estimate the impact that remdesivir -the first drug for COVID-19 approved in EU- would have had in the first wave. Methods: This study estimated the impact on the Spanish National Health System (SNHS) capacity (bed occupancy), and the number of deaths that could have been prevented, based on two scenarios: a real-life scenario (without remdesivir), and an alternative scenario (with remdesivir). It considered the clinical results of the ACTT-1 trial in hospitalized patients with COVID-19 and pneumonia, who required supplemental oxygen. The occupancy rates in general wards and ICUs were estimated in both scenarios. Results: Remdesivir would have avoided the admission of 2,587 patients (43.75%) in the ICUs. It would have also increased the SNHS capacity in 5,656 general wards beds and 1,700 ICU beds, showing an increase in the number of beds available of 17.53% (95% CI: 3.98% - 24.42%), and 23.98% (95% CI: 21.33% - 28.22%), respectively, at the peak of the occupancy rates. Furthermore, remdesivir would have avoided 7,639 deaths due to COVID-19, which implies a 27.51% reduction (95% CI: 14.25% - 34.07%). Conclusions: Remdesivir would have relieved the pressure of the SNHS, and would have reduced the death toll, providing a better strategy for the management of COVID-19 during the first wave.

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