Leadership for integrated care: A case study

Purpose. Integration of health services involves multiple interdependent leaders acting at several levels of their organisation and across organisations. This paper explores the complexities of leadership in an integrated care project and aims to understand what leadership arrangements are needed to enable service transformation. Design/Methodology/Approach. This case study analysed system and organisational leadership on a project aiming to integrate primary and specialist care. To explore the former, the national policy documents and guidelines were reviewed. To explore the latter, the official documents from the transformation team meetings and interview data from seventeen healthcare professionals and commissioners were analysed using thematic analysis with the coding framework derived from the comprehensive and multilevel framework for change. Findings. Although integration was supported in the narratives of the system and organisational leaders, there were multiple challenges: 1) insufficient support by the system level leadership for the local leadership, 2) insufficient organisational support for (clinical) leadership within the transformation team, and 3) insufficient leadership within the transformation team due to disruptions caused by personnel changes, roles ambiguity, conflicting priorities, and insufficient resources. Practical implications. This study provides insights into the interdependencies of leadership across multiple levels and proposes steps to maximise the success of complex transformational projects. Value. This study’s practical findings are useful for those involved in the bottom-up integrated projects, especially the transformation teams’ members. The case study highlights the need for a toolkit enabling local leaders to operate effectively within the system and organisational leadership contexts.

Ahorro y costes potenciales de una intervención para reducir la no adherencia de los pacientes crónicos avanzados

La adherencia al tratamiento es muy baja entre pacientes crónicos avanzados, implicando un gasto aún más alto del que ya es. Esta situación está empeorando debido al crecimiento exponencial del número de pacientes crónicos. Este estudio estima el beneficio neto de una intervención para la reducción de la no-adherencia, que consiste en monitorizar regularmente a los pacientes para evitar errores en la toma de las medicinas

COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic

Background: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children. Objectives: To describe the formation of a global collaboration entitled, ‘COVID-19 Unmasked’. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications. Methods: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1–5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child’s wellbeing, their own mental health, and parenting. Data analysis: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System–Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures

Managing chronic care: how to decrease exacerbations

[cat] El sistema sanitari es veu abocat a afrontar un altre problema, que és l’augment de demanda sanitària que s’està produint en el sector, però que encara serà molt més acusada en els propers anys. Ens els darrers anys, i gràcies a les millores sanitàries i les innovacions mèdiques, s’han pogut salvar moltes vides. Per altra banda, aquests malats ara queden crònics de per vida. Això pel sistema sanitari representa uns costos molts majors, ja que se’ls ha de tractar durant un període de temps molt més llarg. A més, també s’ha d’afegir el fet que aquestes persones necessiten algú que se’n faci càrrec, i degut els canvis demogràfics cada vegada n’hi haurà menys. Observant a un usuari d’edat avançada de qualsevol sistema sanitari europeu o nord-americà, ens trobem que en la seva gran majoria tenen dues malalties cròniques. Aquest pacients són els causants dels 75% de la despesa sanitària. El problema esdevé quan el sistema sanitari espanyol, i la majoria de la resta de sistemes, no són capaços d’adaptar els serveis que ofereixen a les necessitats de la població, i en especial, quan aquesta població creixerà fins en molts casos duplicar-se en nombre cap a l’any 2050. El sistemes sanitaris estan oferint serveis que es focalitzen en una sola malaltia, però la majoria de clients pateixen dues malalties o més a la vegada. Això provoca que aquest pacients rebin un servei poc planificat i pobrament coordinat. Per tal de poder oferir el servei que necessiten i es mereixen aquests usuaris, molts sistemes sanitaris estan evolucionant cap a un sistema de cures més integrades. Aquesta tesi estudia el rol de la infermera gestora de casos, en concret estudia els factors que fan que un pacient hagi de ser derivat a aquesta com a instrument per estudiar els factors que fan que un pacient tingui una crisi de salut. En concret, y després d’un primer estudi general de tots els possibles factors, es centra en el risc social i en la no adherència al tractament com a dos factors clau en la prevenció de l’aparició d’aquestes crisis de salut que pateixen els pacients.[eng] The Spanish Health System and almost every single health system from developed countries, has to face a very important problem that is the raise of the healthcare demand. In the past years, thanks to health and medical innovations, health systems have been able to save many lives. The counterpart however, is that before all the patients that were losing their life, now they remain chronically sick for life. This represents much higher costs for the health system because they have to treat those patients for a much longer period of time. In addition to these medical costs it should also be added the fact that these people need someone who takes care of them. Before, that the person used to be a woman between 35 and 65 years, but now these women no longer remains at home to work. Not only that, but every time families have fewer children, which means there will be fewer people to take care of the elderly. To sum up, more elderly, fewer young people who can take care of them, higher demand for care. Watching an elderly user of any European or American health system, we find that the vast majority (68% of patients aged 65 and above) have two chronic diseases. This type of patient is responsible for 91% of prescriptions prescribed or 76% of visits to doctors. In general terms, they are responsible of 75% of health expenditure. The problem becomes when the Spanish health system and other systems, are not able to adapt the services offered to the needs of the population, especially if these population rang is expected to grow, in many cases even to duplicate in number by 2050. The health systems are offering services that focus on single conditions, but most clients of this service suffer two or more diseases at the same time. This means that patients receive poorly coordinated service, which implies that they are not meeting their needs. In many cases (especially when patients suffer from various unrelated diseases), this can mean that patients do not recover as fast as they should, generating more costs. In order to provide the service they need and deserve, many health systems are evolving towards a more integrated system of care. At a primary level, expanding the role of Nurse Case Managers, which promotes cooperation between different departments and also between the different professionals. This thesis studies the role of the Nurse Case Manager, specifically studies the factors that make a patient to be derived to a Nurse Case Manager, as a tool to study the factors that make a patient have an exacerbations. Specifically, and after a first general study of all possible factors, focuses on social risk and non-adherence to treatment as two key factors in preventing exacerbations

Ahorro y costes potenciales de una intervención para reducir la no adherencia de los pacientes crónicos avanzados

La adherencia al tratamiento es muy baja entre pacientes crónicos avanzados, implicando un gasto aún más alto del que ya es. Esta situación está empeorando debido al crecimiento exponencial del número de pacientes crónicos. Este estudio estima el beneficio neto de una intervención para la reducción de la no-adherencia, que consiste en monitorizar regularmente a los pacientes para evitar errores en la toma de las medicinas

Impact of the covid-19 pandemic on burnout in primary care physicians in Catalonia

Background: Recent demands to raise the clinical quality, improve the patient experience, and decrease costs have progressively increased burnout among primary care physicians. This overstretched situation has been greatly aggravated since the onset of the COVID-19 pandemic. The aim of the study is to analyse the prevalence of burnout among primary care physicians and to assess the impact of the COVID-19 pandemic on burnout. Methods: This was a multicentre longitudinal descriptive study of occupational factors and burnout before and since the start of the COVID-19 pandemic. In order to assess the impact of the pandemic on burnout in primary care physicians, two paired groups of physicians were compared using Wilcoxon's and McNemar's tests. Results: In January 2019, 10% of primary care physicians scored high on all burnout domains. Seven months into the COVID-19 pandemic (October 2020), this percentage increased to 50%. Paired groups analysis showed unprecedented worsening due to the pandemic: emotional exhaustion, which already affected 55% of primary care physicians, jumped to 77%. Conclusions: Burnout is endemic among primary care physicians. It has been associated with lower patient satisfaction, reduced health outcomes, and increased costs. The COVID-19 pandemic has pushed burnout in primary care professionals to the edge

Efecto de la consulta virtual (eConsulta) en la frecuentación de visitas en atención primaria

Resumen: Objetivo: Se realiza un estudio observacional antes y después para valorar el efecto de la consulta virtual (eConsulta) sobre la frecuentación posterior que realiza el paciente a su centro de atención primaria una vez ha realizado su primera consulta virtual. Emplazamiento: Población asignada de los Centros de Atención Primaria Masnou-Alella y Ocata-Teià del Institut Català de la Salut. Participantes: Se realiza un muestreo aleatorizado y se comparan 329 pacientes que realizaron eConsultas respecto de 329 pacientes estadísticamente similares en edad, sexo y complejidad médica que no realizaron ninguna eConsulta. Mediciones principales: Se midieron las visitas realizadas con medicina primaria y enfermería de su equipo, tanto presenciales, telefónicas y eConsultas, durante el periodo de estudio. Resultados: Los pacientes que realizaron consultas virtuales mostraron una frecuentación previa en la atención primaria mayor que aquellos que no realizaron eConsultas (4,44 visitas médicas/año versus 3,11). Tras el uso de la eConsulta, después de un año de seguimiento, su frecuentación se redujo hasta niveles del grupo control (3,16 visitas médicas/año versus 3,00). Tras la primera visita virtual, los pacientes redujeron las visitas presenciales en un 28,7%. Conclusiones: La eConsulta podría ser una herramienta eficaz para dar respuesta a las necesidades de los pacientes que no requieran de una visita presencial, en especial en los pacientes más frecuentadores. Abstract: Objective: A «before and after» type observational study was carried out to assess the impact of the virtual consultation (eConsulta) on the frequency with which the patient visits their primary care center once they have had their first virtual consultation. Setting: Assigned population of the primary care center of Masnou-Alella and Ocata-Teià, Catalan Health Institute. Participants: A random sampling was performed and 329 patients who engaged in eConsulta were compared with 329 statistically similar patients in age, sex and medical complexity who did not engage in eConsulta. Principal mediations: Visits with primary care and nursing in their team are measured, both face-to-face, telephone and eConsulta, over the study period. Results: Patients who performed virtual consultations showed a previous frequent attendance in primary care higher than those who did not perform eConsulta (4.44 medical visits year/versus 3.11). Following the use of the eConsulta, after a year of follow-up, frequency was reduced to levels of the control group (3.16 medical visits/year versus 3.00). After the first virtual visit, patients reduced face-to-face visits by 28.7%. Conclusions: The eConsulta could be an effective tool to respond to the needs of patients who do not require a face-to-face visit, especially in the most frequent patients

Textos i imatges de l'exposició Joan Clapés i Sant Andreu de Palomar

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