Rural-urban differences in the pattern of referrals to an asynchronous teledermatology service

Background Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres. Methods and findings A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices. Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p<0.001). The number of referrals to the face-to-face dermatology service after a teledermatology consultation decreased significantly in both urban [OR=0,81 (0,70-0,93) p=0,001] and rural centres [OR=0,64 (0,57-0,72) p<0,001]. Conclusions The asynchronous teledermatology service established in the Bages County increases the resolution of primary care teams as reduces referrals to the face-to-face dermatology service. This effect is more pronounced in rural than in urban areas. Such finding may indicate the need to prioritize telemedicine services in rural primary care practices

Epidemiology and antimicrobial resistance profile of Neisseria gonorrhoeae in Catalonia, Spain, 2016-2019

Ferran Navarro forma part del grup MRSCAntimicrobial resistance data for Neisseria gonorrhoeae is globally sparse and resistant strains are emerging in Catalonia. We aim to describe epidemiological and antimicrobial resistance in all patients infected with N. gonorrhoeae during the period from 2016 to 2019, using available antimicrobial susceptibility data. We retrospectively analysed confirmed N. gonorrhoeae cases notified to Catalonia's microbiological reporting system. Antibiotic susceptibility testing (azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, spectinomycin, and tetracycline) was assessed using clinical breakpoints published by the European Committee on Antimicrobial Susceptibility Testing. Incidence rates were calculated and proportions were compared using the χ2 test or Fisher's exact test, and analysed using the Statistical Package for Social Sciences (SPSS 18.0). A total of 14,251 confirmed cases of N. gonorrhoeae were notified. Incidence increased from 30.7 cases/100,000 person-years (p < 0.001) in 2016 to 64.7 in 2019. Culture was available in 6,292 isolates (44.2%), of which 5,377 (85.5%) were resistant to at least one of the antibiotics tested. Azithromycin resistance rose from 6.1% in 2016 to 16% in 2019 (p < 0.001). Only 1.0% (45 cases) were resistant to ceftriaxone. Multidrug-resistant N. gonorrhoeae increased from 0.25% in 2016 to 0.42% in 2019 (p = 0.521). One case presented extensively drug-resistant N. gonorrhoeae. In Catalonia, 10% of the N. gonorrhoeae isolates were resistant to azithromycin in the 2016-2019 period. According to World Health Organization guidelines, resistance above 5% indicates an alert to review treatment guidelines. Antimicrobial susceptibility testing in clinical practice followed by surveillance and interventions are essential to monitor trends and prevent the spread of antimicrobial resistance

Diagnostic performance of Ag-RDTs and NAAT for SARS-CoV2 identification in symptomatic patients in catalonia

The use of rapid antigenic tests (Ag-RDTs) to diagnose a SARS-CoV-2 infection has become a common practice recently. This study aimed to evaluate performance of Abbott Panbio™ Ag-RDTs with regard to nucleic acid amplification testing (NAAT) in the early stages of the disease. A cohort of 149, 026 infected symptomatic patients, reported in Catalonia from November 2020 to January 2021, was selected. The positivity rates of the two tests were compared with respect to the dates of symptom onset. Ag-RDTs presented positivity rates of 84% in the transmission phases of the disease and 31% in the pre-symptomatic period, compared to 93% and 91%, respectively, for NAAT. The detection of many false negatives with Ag-RDTs during the pre-symptomatic period demonstrates the risk of virus dissemination with this diagnostic technique if used outside the symptomatic period

A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia

A teledermatology pilot scheme was first conducted in the town of Manresa (Barcelona) in the summer of 2010. The clinical success of the scheme prompted its expansion to the whole county of Bages in 2011 and to the adjacent county of Berguedà in 2012. In the teledermatology service, primary care physicians take a photograph of the lesion and attach it to the electronic medical records of the patient together with a brief clinical account. In the referral hospital, the consultant dermatologists access the electronic medical records, review the images and suggest a treatment or action plan. Next, the primary care physicians review these recommendations and call the patient to report the results. This whole process is usually completed in less than 5 working days. A cost saving analysis comparing teledermatology with dermatology face-to-face visits was performed in the county of Bages measuring the cost difference attributable to visits saved. The estimated added costs of the teledermatology service during 2016 amounted to 61,870 €. For the same period, the estimated costs of traditional outpatient dermatology services were of 113,034 €. This represents savings of 51,164 € per year. After subtraction of societal costs, the savings equal 10,350 € per year. Using a teledermatology service instead of face-to-face dermatology consultations could save 51,164 € per year (11.4 € per patient visited) in the county of Bages. Societal savings are the most significant

L’excés de mortalitat a Catalunya: anàlisi de l’excés de mortalitat de l’1 de juny al 31 d’agost de 2022

Mortalitat; Anàlisi; PoblacióMortalidad; Análisis; PoblaciónMortality; Analysis; PopulationAquest informe és fruit d’un treball col·laboratiu entre la Direcció General de Planificació i Recerca en Salut i la Secretaria de Salut Pública del Departament de Salut, l’Àrea de Sistemes d’Informació del Servei Català de la Salut, el Sistema d’Informació dels Serveis d’Atenció Primària de l’Institut Català de la Salut i el Departament de Física de la Universitat Politècnica de Catalunya, i ha estat dut a terme la tardor de 2022 arran de diferents informacions que han sorgit sobre un increment de la mortalitat entorn dels mesos d’estiu. Aquesta col·laboració explicita la multiplicitat de fonts d’informació, de períodes de referència, d’indicadors i de format en les taules, les figures i els mapes, tot i el treball en comú realitzat a l’hora de seleccionar els continguts, interpretar la informació i redactar-ne les conclusions

SARS-CoV-2 Catalonia contact tracing program : evaluation of key performance indicators

Background: Guidance on SARS-CoV-2 contact tracing indicators have been recently revised by international public health agencies. The aim of the study is to describe and analyse contact tracing indicators based on Catalonia's (Spain) real data and proposing to update them according to recommendations. Methods: Retrospective cohort analysis including Catalonia's contact tracing dataset from 20 May until 31 December 2020. Descriptive statistics are performed including sociodemographic stratification by age, and differences are assessed over the study period. Results: We analysed 923,072 contacts from 301,522 SARS-CoV-2 cases with identified contacts (67.1% contact tracing coverage). The average number of contacts per case was 4.6 (median 3, range 1-243). A total of 403,377 contacts accepted follow-up through three phone calls over a 14-day quarantine period (84.5% of contacts requiring follow-up). The percentage of new cases declared as contacts 14 days prior to diagnosis evolved from 33.9% in May to 57.9% in November. All indicators significantly improved towards the target over time (p < 0.05 for all four indicators). Conclusions: Catalonia's SARS-CoV-2 contact tracing indicators improved over time despite challenging context. The critical revision of the indicator's framework aims to provide essential information in control policies, new indicators proposed will improve system delay's follow-up. The study provides information on COVID-19 indicators framework experience from country's real data, allowing to improve monitoring tools in 2021-2022. With the SARS-CoV-2 pandemic being so harmful to health systems and globally, is important to analyse and share contact tracing data with the scientific community

Epidemiologic Features and Control Measures during Monkeypox Outbreak, Spain, June 2022

During June 2022, Spain was one of the countries most affected worldwide by a multicountry monkeypox outbreak with chains of transmission without identified links to disease-endemic countries. We provide epidemiologic features of cases reported in Spain and the coordinated measures taken to respond to this outbreak.S

Impact of a telemedicine program on the reduction in the emission of atmospheric pollutants and journeys by road

This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability

Clinical characterization of patients with COVID-19 in primary care in Catalonia: retrospective observational study

Background: The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective: The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods: An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results: The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions: We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2