Tiempo de cicatrización de las heridas crónicas, a propósito de un estudio de prevalencia e incidencia

Aim: To determine the mean healing time of chronic wounds as well as their prevalence and incidence.Method: A transversal, retrospective study in the field of primary care in Barcelona city, with a population of 15,589 inhabitants over 15 years of age. The study period was from 1st January to 31st December 2013. Information on the etiology of chronic wounds and the time needed for healing was collected.Results: 416 records of injuries were located, of which 10.33% were chronic wounds. The median duration was 152 days and the mean average was 311 days, with pressure ulcers taking longest to heal. A statistically significant difference (p <0.05) was observed between the mean duration of wounds treated at the health centre and those treated at home. The prevalence was 0.28% and the incidence 0.24%, the wounds with the highest prevalence and incidence were venous ulcers.Conclusions: Healing time depends on the type of wound and the point of care. The highest prevalence and incidence occurs in lower-extremity (leg) ulcers. Objetivo: Determinar el tiempo medio de cicatrización de las heridas crónicas, así como su prevalencia e incidencia.Método: Estudio retrospectivo transversal en el ámbito de atención primaria de Barcelona ciudad, con una población de 15.589 habitantes mayores de 15 años. El periodo de estudio fue de 1 de enero a 31 de diciembre de 2013. Se recogió información sobre la etiología de las heridas crónicas y el tiempo necesario para su cicatrización.Resultados: Fueron localizados 416 registros de lesiones de los cuales el 10,33% pertenecían a heridas crónicas. La mediana de duración fue de 152 días y la media de 311 días, siendo las úlceras por presión las de mayor duración. Se observó una diferencia estadísticamente significativa (p<0,05) entre la media de duración de las heridas atendidas en el centro de salud y las atendidas a domicilio. La prevalencia fue del 0,28% y la incidencia del 0,24%, las lesiones con mayor prevalencia e incidencia fueron las úlceras venosas.Conclusiones: El tiempo de curación depende del tipo de herida y del lugar de atención. La mayor prevalencia e incidencia se da en úlceras de extremidad inferior

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577

Gestión enfermera de la demanda: Estudio de la efectividad del modelo

Treball final de Màster Universitari en Ciències de la Infermeria. Codi: SBL017. Curs acadèmic 2018-2019.Background: nurse management of same-day is the nurse's response to an acute, low-complexity health problem that requires an immediate solution, based on consensual decision algorithms. Objective: to evaluate the effectiveness of the nurse management of same-day model. To check if variables related to the patient or the professional can influence the degree of resolution. Methodology: cross-sectional retrospective study in an urban health center, with an assigned adult population of 16928 users. A random sample of 376 individuals was selected, according to the calculation performed with GRANMO. All nurses in the study center were asked to participate. Study period from 1 January 2018 to 31 December 2018. The variables were collected throughout the clinical history following strict confidentiality criteria. Statistical analysis was carried out with Rcommander. Results: 75.68% of the reasons for consultation were attended only by a nurse and 24.32% were referred to the family doctor. No statistically significant differences were observed when comparing AMG index (p=0.239) and age (p=0.341) with degree of resolution. There was no difference in the type of resolution according to the professional (p=0.095). The sex of the professional and years of professional experience influenced the percentage of autonomous resolution. Perception of whether one is able to address GED influenced nursing resolution. Conclusion: The GED model is efficient. The sample of participating professionals should be expanded to confirm the results.Antecedentes: la Gestión enfermera de la demanda (GED) es aquella respuesta que da la enfermera a un problema agudo de salud, de baja complejidad, que requiere una solución inmediata, basándose en algoritmos de decisión consensuados. Objetivo: evaluar la eficacia del modelo de GED. Comprobar si variables relacionadas con el paciente o el profesional pueden influir en el grado de resolución. Metodología: estudio retrospectivo transversal en un centro de salud urbano, con una población adulta asignada de 16928 usuarios. Se seleccionó una muestra aleatoria de 376 individuos, según el cálculo realizado con GRANMO. Se solicitó la participación a la totalidad de enfermeras del centro de estudio. Período de estudio de 1 de enero de 2018 a 31 diciembre de 2018. Las variables fueron recogidas a través de la histórica clínica siguiendo estrictos criterios de confidencialidad. Se procedió al análisis estadístico con R-commander. Resultados: el 75,68% de los motivos de consulta fueron atendidos sólo por enfermería y el 24,32% fueron derivados al médico de familia. No se observaron diferencias estadísticamente significativas al comparar el índice GMA (p=0,239) y la edad (p=0,314) con el grado de resolución. No se observaron diferencias en el tipo de resolución según el profesional (p=0,095). El sexo del profesional y los años de experiencia profesional influyeron en el porcentaje de resolución autónoma. La percepción sobre si se está capacitada para abordar la GED influyó en la resolución enfermera. Conclusión: el modelo de GED resulta eficiente. Se debería ampliar la muestra de profesionales participantes para ratificar los resultados

Tiempo de cicatrización de las heridas crónicas, a propósito de un estudio de prevalencia e incidencia

Aim: To determine the mean healing time of chronic wounds as well as their prevalence and incidence.Method: A transversal, retrospective study in the field of primary care in Barcelona city, with a population of 15,589 inhabitants over 15 years of age. The study period was from 1st January to 31st December 2013. Information on the etiology of chronic wounds and the time needed for healing was collected.Results: 416 records of injuries were located, of which 10.33% were chronic wounds. The median duration was 152 days and the mean average was 311 days, with pressure ulcers taking longest to heal. A statistically significant difference (p <0.05) was observed between the mean duration of wounds treated at the health centre and those treated at home. The prevalence was 0.28% and the incidence 0.24%, the wounds with the highest prevalence and incidence were venous ulcers.Conclusions: Healing time depends on the type of wound and the point of care. The highest prevalence and incidence occurs in lower-extremity (leg) ulcers. Objetivo: Determinar el tiempo medio de cicatrización de las heridas crónicas, así como su prevalencia e incidencia.Método: Estudio retrospectivo transversal en el ámbito de atención primaria de Barcelona ciudad, con una población de 15.589 habitantes mayores de 15 años. El periodo de estudio fue de 1 de enero a 31 de diciembre de 2013. Se recogió información sobre la etiología de las heridas crónicas y el tiempo necesario para su cicatrización.Resultados: Fueron localizados 416 registros de lesiones de los cuales el 10,33% pertenecían a heridas crónicas. La mediana de duración fue de 152 días y la media de 311 días, siendo las úlceras por presión las de mayor duración. Se observó una diferencia estadísticamente significativa (p<0,05) entre la media de duración de las heridas atendidas en el centro de salud y las atendidas a domicilio. La prevalencia fue del 0,28% y la incidencia del 0,24%, las lesiones con mayor prevalencia e incidencia fueron las úlceras venosas.Conclusiones: El tiempo de curación depende del tipo de herida y del lugar de atención. La mayor prevalencia e incidencia se da en úlceras de extremidad inferior

Time of chronic wound healing, as part of a prevalence and incidence study

Objetivo: Determinar el tiempo medio de cicatrización de las heridas crónicas, así como su prevalencia e incidencia. Método: Estudio retrospectivo transversal en el ámbito de atención primaria de Barcelona ciudad, con una población de 15.589 habitantes mayores de 15 años. El periodo de estudio fue de 1 de enero a 31 de diciembre de 2013. Se recogió información sobre la etiología de las heridas crónicas y el tiempo necesario para su cicatrización. Resultados: Fueron localizados 416 registros de lesiones de los cuales el 10,33% pertenecían a heridas crónicas. La mediana de duración fue de 152 días y la media de 311 días, siendo las úlceras por presión las de mayor duración. Se observó una diferencia estadísticamente significativa (p<0,05) entre la media de duración de las heridas atendidas en el centro de salud y las atendidas a domicilio. La prevalencia fue del 0,28% y la incidencia del 0,24%, las lesiones con mayor prevalencia e incidencia fueron las úlceras venosas. Conclusiones: El tiempo de curación depende del tipo de herida y del lugar de atención. La mayor prevalencia e incidencia se da en úlceras de extremidad inferior.ABSTRACT: Aim: To determine the mean healing time of chronic wounds as well as their prevalence and incidence. Method: A transversal, retrospective study in the field of primary care in Barcelona city, with a population of 15,589 inhabitants over 15 years of age. The study period was from 1st January to 31st December 2013. Information on the etiology of chronic wounds and the time needed for healing was collected. Results: 416 records of injuries were located, of which 10.33% were chronic wounds. The median duration was 152 days and the mean average was 311 days, with pressure ulcers taking longest to heal. A statistically significant difference (p <0.05) was observed between the mean duration of wounds treated at the health centre and those treated at home. The prevalence was 0.28% and the incidence 0.24%, the wounds with the highest prevalence and incidence were venous ulcers. Conclusions: Healing time depends on the type of wound and the point of care. The highest prevalence and incidence occurs in lower-extremity (leg) ulcers

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study.

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577

Autonomy, power dynamics and antibiotic use in primary healthcare : A qualitative study

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID:

A Co-Design Process to Elaborate Educational Materials to Promote Appropriate Use of Antibiotics for Acute Lower Respiratory Tract Infections in Primary Healthcare in Catalonia (Spain)

Co-design processes with patients allow developing health education materials, that are adapted to the population's knowledge and use of language, to reduce inappropriate antibiotic use. This study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019. Twenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants' narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used. The co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy

Effectiveness and cost-effectiveness of Improving clinicians’ diagnostic and communication skills on antibiotic prescribing appropriateness in patients with acute cough in primary care in CATalonia (the ISAAC-CAT study): study protocol for a cluster randomised controlled trial

Background Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres. Methods/design A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out. Discussion The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines.The research is being funded by a grant from the Fundació La Marató de TV3 (reference no. 201820)