Resposta dels Serveis Socials de la Mancomunitat del Pla de Mallorca a les persones grans de la Mancomunitat del Pla

El present article efectua un recorregut al llarg de la Mancomunitat del Pla de Mallorca per tal de poder exposar les prestacions i els serveis que té a la seva disposició la nostra gent gran. Cal tenir en compte que la Mancomunitat del Pla de Mallorca és la zona més envellida de la nostra illa: aquesta realitat fa que a l’hora de planificar des dels Serveis Socials Comunitaris, es prioritzi el sector de la gent gran. El 2008 els Serveis Socials Comunitaris de la Mancomunitat del Pla de Mallorca varen implementar el sistema de dependència, la qual cosa ens ha permès realitzar unes reflexions per afrontar el futur amb uns serveis de qualitat i adaptats a la realitat d’una societat en permanent canvi. Aquest fet ha suposat un gran esforç per part de l’equip tècnic del Departament de Serveis Socials Comunitaris, ja que s’ha hagut de reestructurar de bell nou per adaptar-se a aquesta realitat, amb el convenciment de treballar per millorar i apropar els serveis a la ciutadania dels municipis del Pla de Mallorca.El presente artículo efectúa un recorrido a lo largo de la Mancomunitat Pla de Mallorca con el fin de poder exponer las prestaciones y servicios que están a disposición de nuestros mayores. Se tiene que tener en cuenta que la Mancomunitat Pla de Mallorca es la zona más envejecida de nuestra Isla, esta realidad hace que a la hora de planificar desde los servicios sociales comunitarios se priorice el sector de las personas mayores. En el 2008 los servicios sociales comunitarios de la Mancomunitat Pla de Mallorca implementaron el sistema de dependencia, lo cual nos ha permitido realizar unas reflexiones para encarar un futuro con unos servicios de calidad y adaptados a la realidad de una sociedad en permanente cambio. Este hecho ha supuesto un gran esfuerzo por parte del equipo técnico del departamento de servicios sociales comunitarios, ya que se ha tenido que reestructurar de nuevo para adaptarse a esta realidad, con el convencimient

Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial.

BackgroundCurrent benzodiazepine (BZD) prescription guidelines recommend short-term use to minimize the risk of dependence, cognitive impairment, and falls and fractures. However, many clinicians overprescribe BZDs and chronic use by patients is common. There is limited evidence on the effectiveness of interventions delivered by general practitioners (GPs) on reducing prescriptions and long-term use of BZDs. We aimed to evaluate the effectiveness of a multicomponent intervention for GPs that seeks to reduce BZD prescriptions and the prevalence of long-term users.Methods and findingsWe conducted a multicenter two-arm, cluster randomized controlled trial in 3 health districts in Spain (primary health centers [PHCs] in Balearic Islands, Catalonia, and Valencian Community) from September 2016 to May 2018. The 81 PHCs were randomly allocated to the intervention group (n = 41; 372 GPs) or the control group (n = 40; 377 GPs). GPs were not blinded to the allocation; however, pharmacists, researchers, and trial statisticians were blinded to the allocation arm. The intervention consisted of a workshop about the appropriate prescribing of BZDs and tapering-off long-term BZD use using a tailored stepped dose reduction with monthly BZD prescription feedback and access to a support web page. The primary outcome, based on 700 GPs (351 in the control group and 349 in the intervention group), compared changes in BZD prescriptions in defined daily doses (DDDs) per 1,000 inhabitants per day after 12 months. The 2 secondary outcomes were the proportion of long-term users (≥6 months) and the proportion of long-term users over age 65 years. Intention-to-treat (ITT) analysis was used to assess all clinical outcomes. Forty-nine GPs (21 intervention group and 28 control group) were lost to follow-up. However, all GPs were included in the ITT analysis. After 12 months, there were a statistically significant decline in total BZD prescription in the intervention group compared to the control group (mean difference: -3.24 DDDs per 1,000 inhabitants per day, 95% confidence interval (CI): -4.96, -1.53, p 0.001), and the adjusted absolute difference in long-term users over age 65 years was -0.87 (95% CI: -1.44, -0.30, p = 0.003). A key limitation of this clustered design clinical trial is the imbalance of some baseline characteristics. The control groups have a higher rate of baseline BZD prescription, and more GPs in the intervention group were women, GPs with a doctorate degree, and trainers of GP residents.ConclusionsA multicomponent intervention that targeted GPs and included educational meeting, feedback about BZD prescriptions, and a support web page led to a statistically significant reduction of BZD prescriptions and fewer long-term users. Although the effect size was small, the high prevalence of BZD use in the general population suggests that large-scale implementation of this intervention could have positive effects on the health of many patients.Trial registrationISRCTN ISRCTN28272199

Evaluating the Implementation of a Multicomponent Intervention Consisting of Education and Feedback on Reducing Benzodiazepine Prescriptions by General Practitioners: BENZORED Hybrid Type I Cluster Randomized Controlled Trial

Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited, and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type-1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze the facilitators and barriers regarding the implementation of the intervention in primary care settings. Methods: A qualitative interview study with 40 GPs from three Spanish health districts. Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate, and analyze the data. Results: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: the complexity of the intervention, the individual Stage of Change, and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: adaptability in the intervention, external policy and incentives, implementation climate, relative priority, self-efficacy, compatibility, and engaging a formally appointed implementation leader. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation. Conclusions: We identified constructs that could explain differences in the efficacy in implementation of the intervention. This information is relevant for the design of successful strategies for implementation of the intervention