Actividad física y calidad de vida por parte de los pacientes de la atención primaria de la ciudad de Terrassa (Physical activity and quality of life by patients of primare care of the city of Terrassa)

En el artículo se describen y analizan los resultados de un estudio realizado para investigar la relación entre la práctica físico-deportiva y la calidad de vida percibida (CVP). La muestra del estudio estuvo integrada por un colectivo de ciudadanos (968), pacientes de Atención Primaria, entrevistados mientras se encontraban en las salas de espera, de cuatro Centros de Atención Primaria (CAP) de la ciudad de Terrassa. Los objetivos del estudio fueron: 1) Evaluar la relación entre la percepción de calidad de vida y la actividad físico-deportiva; 2) Verificar si, en tal percepción, hay diferencias significativas entre hombres y mujeres. Las conclusiones fueron las siguientes: Existe una percepción mejor de la calidad de vida entre los usuarios que realizan actividad físico-deportiva que entre los pacientes sedentarios, sea la actividad moderada o intensa. Las mujeres que realizan actividad físico-deportiva mejoran su percepción de Calidad de Vida en mayor grado que los hombres. Las mujeres mejoran su CVP en el ámbito social y los hombres en el ámbito físico, por lo que la práctica deportiva es una fuente de la socialización de las mujeres. Abstract. The article describes and analyzes the results of a study carried out to investigate the relationship between physical-sports practice and perceived quality of life (QOL). The study sample was made up of a group of citizens (968), Primary Care patients, interviewed while they were in the waiting rooms of four Primary Care Centers (CAP) in the city of Terrassa. The objectives of the study were: 1) To evaluate the relationship between the perception of quality of life and physical-sports activity; 2) Verify if, in such perception, there are significant differences between men and women. The conclusions were as follows: There is a better perception of the quality of life among users who perform physical-sports activity than among sedentary patients, be it moderate or intense activity. Women who perform physical-sports activity improve their perception of Quality of Life to a greater degree than men. Women improve their CVP in the social sphere and men in the physical sphere, so sports practice is a source of women's socialization.

Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

Assessing the implementation of a clinical decision support tool in primary care for diabetes prevention: a qualitative interview study using the Consolidated Framework for Implementation Science

Background In this paper we describe the use of the Consolidated Framework for Implementation Research (CFIR) to study implementation of a web-based, point-of-care, EHR-linked clinical decision support (CDS) tool designed to identify and provide care recommendations for adults with prediabetes (Pre-D CDS). Methods As part of a large NIH-funded clinic-randomized trial, we identified a convenience sample of interview participants from 22 primary care clinics in Minnesota, North Dakota, and Wisconsin that were randomly allocated to receive or not receive a web-based EHR-integrated prediabetes CDS intervention. Participants included 11 clinicians, 6 rooming staff, and 7 nurse or clinic managers recruited by study staff to participate in telephone interviews conducted by an expert in qualitative methods. Interviews were recorded and transcribed, and data analysis was conducted using a constructivist version of grounded theory. Results Implementing a prediabetes CDS tool into primary care clinics was useful and well received. The intervention was integrated with clinic workflows, supported primary care clinicians in clearly communicating prediabetes risk and management options with patients, and in identifying actionable care opportunities. The main barriers to CDS use were time and competing priorities. Finally, while the implementation process worked well, opportunities remain in engaging the care team more broadly in CDS use. Conclusions The use of CDS tools for engaging patients and providers in care improvement opportunities for prediabetes is a promising and potentially effective strategy in primary care settings. A workflow that incorporates the whole care team in the use of such tools may optimize the implementation of CDS tools like these in primary care settings. Trial registration Name of the registry: Clinicaltrial.gov. Trial registration number: NCT02759055. Date of registration: 05/03/2016. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT02759055 Prospectively registered.

A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

Background The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Methods Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. Results 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763–0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863–0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7–92.1) and specificity of 67.8% (95% CI 55.1–78.3). Conclusions The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979. Date of registration: October 30, 2015.