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Abstract Background A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals’ profiles in the tool’s implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users’ expectations, by establishing the determining factors that had an influence on the physicians’ intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. Methods Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH’s implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool’s consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. Results We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. Conclusions The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals.

Abstract Background The current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use. Methods A descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions. Results For a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations. Conclusions The collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use.

Abstract Background The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. Methods Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years – the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. Results The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged

Following publication of the original article [1], the authors opted to update affiliation 3 in order to comply with the current regulations for the submission of Doctoral Thesis by compendium of articles, the Universitat Autónoma de Barcelona Doctoral School asks us to update the affiliation number 3, adding “Departament de Medicina” at the beginning, as follows:

Following publication of the original article [1], in order to comply with the current regulations for the submission of Doctoral Thesis by compendium of articles, the Universitat Autónoma de Barcelona Doctoral School asks us to update the affiliation number 3, adding “Departament de Medicina” at the beginning, as follows:

Abstract Background Spanish Organic Law 2/2010 legalizes abortion within 14 weeks of gestation. Medical abortion with mifepristone and misoprostol is around 97% effective and is offered at primary care centers during the first 9 weeks of gestation. It consists of the administration of 200 mg of mifepristone by a healthcare professional and of the self-administration 800 mg of misoprostol by the patient at home, along with prescribed analgesics. However, the quality of this process as perceived by patients has never been assessed. This study aims to validate a scale designed to assess the perceived quality of the entire process, structure and results of at-home medical abortion. Methods Validation study of a Spanish adaptation of the SERVPERF scale. In total, 289 patients completed a self-administered questionnaire consisting of 26 items previously evaluated by a group of experts. A re-test was performed on 53 of these patients 15 days later to assess interobserver consistency. Results The highest non-response rate for any single item was 2.1%. The floor effect was 26% and the ceiling effect did not surpass 83%. The linearly weighted Kappa coefficient was good to excellent, in general. An exploratory factor analysis was performed with Varimax rotation, obtaining a total of 7 dimensions that explain 65.9% of the variability. The internal consistency (Cronbach's alpha) for all items was 0.862. Conclusion This psychometric instrument is valid and reliable for assessing the quality of care of medical abortion. Medical abortion is efficient, effective and eliminates the need for hospital care, anesthesia and surgical risk. However, user satisfaction has yet to be determined. This study offers a validated scale to assess perceived quality of care, their quality experience and person-centered care for abortion as a fundamental part of overall service quality as a fundamental part of overall service quality.