A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country

is properly cited. Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP) in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT) effects. Methods. Ten health centers (HCs) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8-15 people. The ability of each HC in forming up to 2 groups, participants' compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c) was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394

La multimorbilidad vista desde la perspectiva de los profesionales de atención primaria

Objetivo: Explorar la percepción de profesionales clínicos de atención primaria del País Vasco sobre la multimorbilidad y su influencia en la práctica clínica y en la organización de la prestación sanitaria. Diseño: Estudio cualitativo basado en entrevistas, taller de storytelling y cocreación. Emplazamiento: Comunidad autónoma del País Vasco. Atención primaria de Osakidetza. Participantes: Participaron 14 profesionales clínicos: 6 especialistas de medicina de familia, 3 especialistas hospitalarios (medicina interna, neumología y geriatría), 4 profesionales de enfermería, y una profesional de farmacia comunitaria. Métodos: Estudio de carácter cualitativo, exploratorio, basado en un taller de cocreación (12 participantes) y 10 entrevistas con profesionales sanitarios. La investigación se llevó a cabo entre los meses de febrero a junio de 2013. Todas las entrevistas y el taller grupal se grabaron en formato audio y algunas de ellas en formato vídeo. Resultados: Los temas emergentes dominantes fueron: a) los retos que plantea la multimorbilidad para un sistema sanitario “centrado en la enfermedad”; b) la manifestación de esos retos en la práctica clínica cotidiana en aspectos como la relación professional-paciente, la toma de decisiones clínicas, el manejo de la polifarmacia y la coordinación entre ámbitos asistenciales; c) las barreras existentes para un manejo apropiado de estos pacientes: formación, herramientas de ayuda a la decisión, falta de tiempo, etc., y d) la cuestión de las competencias y perfiles profesionales más adecuados. Conclusiones: El aumento de la multimorbilidad es una realidad que preocupa a los profesionales de atención primaria. Los profesionales manifiestan la necesidad de disponer formación adecuada y de sistemas de ayuda a la decisión y de soporte de la práctica diaria que contemplen las situaciones y combinaciones de multimorbilidad más frecuentes. Un abordaje más efectivo de esta problemática requiere un cambio en el modelo sanitario que privilegie una visión integral del paciente, la transición de un enfoque paternalista a uno más proactivo y el desarrollo de la integración asistencial

A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country

Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP) in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT) effects. Methods. Ten health centers (HCs) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8–15 people. The ability of each HC in forming up to 2 groups, participants’ compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c) was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394