Telemedicine for quality control of spirometry in primary care. Results 6 years after implantation in a public health system

Background:The implementation of an FLS in the Spanish public health system is not an easy task since there are no official plans for the incorporation of personnel dedicated to the unitObjectives:To expose the consolidation and improvement of an FLS after its implementation as well as the problems that have arisen over time.Methods:The health program for secondary fracture prevention was implemented in 2012. Initially worked with the same staff assigned to the Rheumatology service, since 2016 we have a part-time support nurse. Patients are identified from the emergency registry and, more recently, from patients admitted for hip fracture and treated in a monographic osteoporosis clinic. The baseline visit consists of consultation with the nurse, DXA and bone metabolism analytics. Falling patients are referred to a fall prevention school. Most patients are referred to their primary care physician to start a treatment.Results:Of the 2,416 patients attended the baseline visit, 30% were forearm fractures, 27% hip, 20% humerus, 10% spine and 11% other fractures. In comparison to 2012, in 2019 the monthly average of patients has doubled, increased the number of hip and spine fractures, and increased the percentage of captured patients (Table). In spite of consolidating the unit, getting a support nurse for the admitted patients and establishing a solid alliance with primary care, it is pending the involvement of Primary Care Nurses and start first prescription at the hospital.Table.Comparison of the first year with the last year of implementation of our FLS.20122019Mean monthly number of fractures, N2242Type of fracture: forearm/hip/spine, %37/20/628/40/11Captured patients of elegible, %5777Delay in weeks until first visit to FLS, median1412Patient origin: emergency list/inpatient/outpatient, %100/0/059/31/9DXA performed, %10061Referral to fall prevention school, %026Criteria to start a treatment, %6790*Referral to the osteoporosis clinic, %377*We apply the 2019 recommendations of the Spanish Society of RheumatologyConclusion:We present the achievements made by our FLS along 8 years and the difficulties within the Spanish public health system.Disclosure of Interests:Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Amparo Molina Speakers bureau: AMGEN, STADA, Cristina Sepúlveda: None declared, Candelaria Torres: None declared, Fabiola Santana: None declared, Francisco Rubiño: None declared, Rubén López: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO

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The PIRASOA® programme: implementation and first outcomes of an antimicrobial stewardship programme based on educational interviews in primary care of the public health system of Andalusia, Spain.

10.26226/morressier.56d5ba26d462b80296c94c22 ◽

2016 ◽

Author(s):

Jose Miguel Cisneros Herreros

Keyword(s):

Public Health ◽

Primary Care ◽

Health System ◽

Antimicrobial Stewardship ◽

Public Health System ◽

Programme Implementation ◽

The Public

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Effectiveness of a Physical Therapeutic Exercise Programme for Caregivers of Dependent Patients: A Pragmatic Randomised Controlled Trial from Spanish Primary Care

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207359 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7359

Author(s):

Federico Montero-Cuadrado ◽

Miguel Ángel Galán-Martín ◽

Javier Sánchez-Sánchez ◽

Enrique Lluch ◽

Agustín Mayo-Iscar ◽

...

Keyword(s):

Public Health ◽

Quality Of Life ◽

Primary Care ◽

Health System ◽

Public Health System ◽

Experimental Treatment ◽

Control Group ◽

Therapeutic Exercise ◽

Care Programme

Female family caregivers (FFCs) constitute one of the basic supports of socio-health care for dependence in developed countries. The care provided by FFCs may impact their physical and mental health, negatively affecting their quality of life. In order to alleviate the consequences of providing care on FFCs, the Spanish Public Health System has developed the family caregiver care programme (FCCP) to be applied in primary care (PC) centres. The effectiveness of this programme is limited. To date, the addition of a physical therapeutic exercise (PTE) programme to FCCP has not been evaluated. A randomised multicentre clinical trial was carried out in two PC centres of the Spanish Public Health System. In total, 68 FFCs were recruited. The experimental group (EG) performed the usual FCCP (4 sessions, 6 h) added to a PTE programme (36 sessions in 12 weeks) whereas the control group performed the usual FCCP performed in PC. The experimental treatment improved quality of life (d = 1.17 in physical component summary), subjective burden (d = 2.38), anxiety (d = 1.52), depression (d = 1.37) and health-related physical condition (d = 2.44 in endurance). Differences between the groups (p < 0.05) were clinically relevant in favour of the EG. The experimental treatment generates high levels of satisfaction.

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Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019

PLoS ONE ◽

10.1371/journal.pone.0253063 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253063

Author(s):

Daniel da Silva Pereira Curado ◽

Dalila Fernandes Gomes ◽

Thales Brendon Castano Silva ◽

Paulo Henrique Ribeiro Fernandes Almeida ◽

Noemia Urruth Leão Tavares ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Health System ◽

Public Health System ◽

Antihypertensive Drugs ◽

Circulatory System ◽

Total Cost ◽

Systemic Arterial Hypertension ◽

Circulatory System Diseases ◽

The Cost

Introduction Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. Objective To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. Methods A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. Results The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. Conclusion Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.

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Telemedicine Spirometry Training and Quality Assurance Program in Primary Care Centers of a Public Health System

Telemedicine Journal and e-Health ◽

10.1089/tmj.2013.0111 ◽

2014 ◽

Vol 20 (4) ◽

pp. 388-392 ◽

Cited By ~ 19

Author(s):

Nuria Marina Malanda ◽

Elena López de Santa María ◽

Asunción Gutiérrez ◽

Juan Carlos Bayón ◽

Larraitz Garcia ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Quality Assurance ◽

Health System ◽

Public Health System ◽

Quality Assurance Program

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Characteristics of citizens and their use of teleconsultation in Primary Care in the Catalan public health system before and during COVID: Retrospective Descriptive Cross-Sectional Study (Preprint)

10.2196/preprints.28629 ◽

2021 ◽

Author(s):

Oscar Solans ◽

Josep Vidal-Alaball ◽

Pasqual Roig Cabo ◽

Núria Mora ◽

Ermengol Coma ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Health System ◽

Rural Areas ◽

Public Health System ◽

Descriptive Analysis ◽

Low Complexity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Predominantly Female

BACKGROUND eConsulta (asynchronous and two-way teleconsultation in Primary Care) is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the outbreak of the pandemic. It is vitally important to know the characteristics of its users in order to be able to meet their needs and have an idea of who is being covered (and who is not) through this service in a context where there is less accessibility to the health system. OBJECTIVE Undertake a descriptive analysis of the profile of the citizens who use the tool and the type of use they make of it to gain an understanding of the elements that characterize their decision to use it, making a distinction between those who used it before and those who have used it since the outbreak of the COVID-19 pandemic METHODS Descriptive observational study based on administrative data. The study differentiates between the pre and during COVID periods, taking as the cut-off point the day the state of emergency was declared in Spain (13 March 2020), and between users who send messages and those who only receive them. The main study variable is the use of the eConsulta service. RESULTS The pandemic has resulted in almost triple the number of unique users in just the first three months observed (220,043/76,598, 2.87). Since the start of the COVID outbreak, although users have continued to be predominantly female, they are systematically younger than before, more actively employed and with less complex pathologies for the two user profiles analysed. There is also a relative decrease in the number of conversations initiated by higher-income urban citizens and an increase in users in rural areas. CONCLUSIONS This study identifies a change in the profile of citizens who use the eConsulta tool, which as a result of the COVID-19 pandemic now has a profile similar to that of the average citizen: actively employed, with low complexity of pathology and who receives more messages proactively from the health professionals through eConsulta. The pandemic has helped to generalize the use of telemedicine as a tool to compensate to some extent for the decline in face-to-face visits, especially in younger citizen profiles.

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