Atencion Primaria最新文献

Objective

To characterize the profile of the informal primary caregiver (IPC) of adult patients with type 2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC).

Design

Observational, descriptive, cross-sectional and analytical study.

Site

Ambulatory Care Medical Unit.

Participants

Mexican CPIs of adult patients with T2D.

Main measurements

Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed.

Results

The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income < 8,900 Mexican pesos, own home, inhabited by a maximum of 5 inhabitants, with support networks, who have dedicated > 5 years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR = 11.03; 95% CI: 1.49-81.95), having a history of more than 5 years of having assumed the role of caregiver (OR = 2, 65; 95% CI: 1.07-6.55), living in one's own house (OR = 3.03; 95% CI: 1.04-8.82), with 6 or more inhabitants (OR = 2.41; 95% CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR = 0.15; 95% CI: 0.07-0.33).

Conclusions

Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks.

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands’ advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe.

Diabetes is a highly prevalent, chronic disease that over time generates potentially serious complications. In the treatment of diabetes, the use of drugs that have shown significant benefits is important, but, in addition, the use of non-pharmacological interventions is essential, which constitute an efficient and effective way to reduce the appearance of diabetes itself and the complications of the disease. These interventions, which are described here, include health education, aimed at incorporating a healthier lifestyle, dietary modifications, increased physical activity or psychological support. Finally, the characteristics that a care system for people with diabetes must meet to achieve the established objectives are discussed.

Violence against physicians is not a newly emerged but an increasingly serious problem. Various studies have reported a prevalence of up to 90%. If not prevented, it not only causes physical and mental harm to physicians who are dedicated to serving humanity but also affects the entire healthcare system and, consequently, the whole community with its direct and indirect effects. Some interventions have a positive outcome when effectively managed. However, for these interventions to be permanent and effective, they need to be multidisciplinary, legally backed and adopted as public policy. In this article, the prevalence of violence against physicians in the literature, its causes, practices worldwide, and suggestions for solving this problem are compiled.

Objective

To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness.

Design

Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023.

Location

Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona).

Participants

People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center.

Method

Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques.

Results

Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1) concept and identification of people experiencing homelessness; (2) personal factors of people experiencing homelessness; (3) behaviors and attitudes of professionals; (4) structural factors related to health system regulation, anf (5) internal organizational factors of primary health care centers.

Conclusions

People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.

Objective

To evaluate the impact of a pharmaceutical intervention on treatment optimization in patients with type 2 diabetes mellitus.

Design

Before-after intervention study.

Site

Health centers of the Primary Care Department of Camp de Tarragona.

Participants

Patients aged ≥ 18 years, diagnosed with type 2 diabetes mellitus and under treatment with antidiabetic drugs.

Interventions

Review of pharmacological treatment for type 2 diabetes mellitus and issuance of proposals for its adequacy.

Main measurements

Demographic and clinical variables were collected to assess the adequacy of antidiabetic treatment. A consensus meeting was arranged with the patients’ primary care physician to evaluate the proposals for improvement. The implementation of the proposals and the variation in postintervention glycemic control were assessed.

Results

A total of 907 patients (59% men) were included. A total of 782 proposals for intervention were made in 65.8% of the patients reviewed. Of the proposals, 43.5% corresponded to drug discontinuation, 16% to intensification of dosing and 12.6% to exchange for a therapeutic equivalent. Of the consensual proposals, 54.7% were implemented. HbA1c was reduced by 0.2% after the intervention (7.4 vs 7.2%).

Conclusions

Review of the pharmacological treatment of patients with type 2 diabetes mellitus by a pharmacist or pharmacologist facilitates its optimization.

Objective

This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique.

Design

An assessment instrument with 53 items has been designed.

Site

It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care.

Participants

The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process.

Intervention

It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus.

Main measurements

All items were accepted with a score higher than 60%.

Results

There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee.

Conclusion

After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Objective

To explore the needs, motivations, and limitations related to healthy eating and digital materials, as well as to identify patterns for their design as a strategy aimed at Mexican families.

Design

A qualitative observational study of the phenomenon through focus group sessions.

Location

A public primary education center in the city of Querétaro, Mexico.

Participants

Children aged 9 to 11 years and parents, mothers, or caregivers with children in primary education.

Method

Twelve sessions were conducted with three groups of students and two sessions with parents, mothers, or caregivers using an interview guide. Various digital materials, developed based on social cognitive theory, were presented during the sessions. The sessions were recorded with the participants’ or their guardians’ prior consent and transcribed for analysis. Coding was performed for key points of analysis, and information saturation was confirmed.

Results

Students expressed motivation towards digital material that promotes play and experimentation, especially within the family context. The main perceived barrier was the caregivers’ resistance to change. Parents expressed motivation and a need for explanatory material on diseases, with economic and time-related barriers.

Conclusions

Digital material based on social cognitive theory, designed to improve nutrition, can be an effective strategy in nutritional education if it considers the circumstances of the target population. It is advisable to include affective and behavioral elements to achieve meaningful learning within households.