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We assessed the impact of the COVID-19 pandemic in Spain on new cases of diseases and conditions commonly seen in primary care. In 2020, there were significant reductions from 2017-2019 in the annual incidences of hypertension (40% reduction), hypercholesterolemia (36%), type 2 diabetes (39%), chronic kidney disease (43%), ischemic heart disease (48%), benign prostatic hypertrophy (38%), osteoporosis (40%), hypothyroidism (46%), chronic obstructive pulmonary disease (50%), alcohol use disorder (46%), benign colon polyps and tumors (42%), and melanomas (45%). Prioritization of COVID-19 care changed the physician-patient relationship to the detriment of face-to-face scheduled visits for chronic disease detection and monitoring, which fell by almost 41%. To return to prepandemic levels of diagnosis and management of chronic diseases, primary health care services should reorganize and carry out specific actions for groups at higher risk.VISUAL ABSTRACTAnnals "Online First" article. [ABSTRACT FROM AUTHOR]

Rationale aims and objectives The increasing amount of the clinical research conducted in the primary health care has enabled extending research beyond traditional settings, but this transfer has implied some trade-offs. Health care professionals who conduct research with trusted patients require assuming the ethical standards of research and communication skills to enable patients' autonomy and freedom of choice. This study aims to measure the opinions of health professionals and patients on issues of communication in clinical research. Method A cross-sectional study with health care professionals and patients from primary health care centres in Barcelona ( Spain). Each group completed a similar self-administered questionnaire. A Rasch model was fitted to data. After examination of goodness-of-fit, differences between groups were compared using analysis of variance, and patients' measures were calibrated to professionals' measures to compare overall mean measures. Results Professionals and patients found the ethical attitudes most difficult to endorse related to trust in clinical researchers and conflicts of interest. Patients' perceptions of professional ethical behaviour were significantly lower than professionals'. Different item functioning between nurses and family doctors was found in the item on seeking ethical collaboration when collaborating in clinical research. Effective knowledge of ethical norms was associated with greater perceived ethical values in clinical research and confidence in health care professionals among patients. Conclusions Differences in the views of the communication process between patients and professionals could alert research boards, health care institutions and researchers to the need for greater transparency, trust and ethical instruction when patients are involved in clinical research. [ABSTRACT FROM AUTHOR]

Aims and objectives. To develop an instrument to measure nurses' ethical sensitivity and, secondarily, to use this instrument to compare nurses' ethical sensitivity between groups. Background. Professional codes of conduct are widely accepted guidelines. However, their efficacy in daily nursing practice and influence on ethical sensitivity is controversial. Design. A descriptive cross-sectional study was conducted. Participants. One hundred and forty-three registered nurses from Barcelona (Spain) participated in the study, of whom 45·83% were working in primary health care and 53·84% in hospital wards. Methods. A specifically designed confidential, self-administered questionnaire assessing ethical sensitivity was developed. Knowledge of the nursing code and data on ethical sensitivity were summarised, with the quality of the questionnaire assessed using Rasch analysis. Results. Item on knowledge of the code showed that one-third of nurses knew the contents of the code and two-thirds had limited knowledge. To fit the Rasch model, it was necessary to rescore the rating scale from five to three categories. Residual principal components analysis confirmed the unidimensionality of the scale. Three items of the questionnaire presented fit problems with the Rasch model. Although nurses generally have high ethical sensitivity to their code of conduct, differences were found according to years of professional practice, place of work and knowledge of the code ( p < 0·05). Conclusions. The questionnaire showed acceptable psychometric properties to achieve the proposed objective. Nurses' ethical sensitivity to the norms of the code was high. However, many factors might influence the degree of ethical sensitivity. Further research to measure ethical sensitivity using invariant measures such as Rasch units would be valuable. Relevance to clinical practice. Other factors, such as assertiveness or courage, should be considered to improve ethical sensitivity to the code of conduct. Rigorous measurement studies and analysis in applied ethics are needed to assess ethical performance in practice. [ABSTRACT FROM AUTHOR]

This cluster randomised clinical trial carried out in 20 primary care centres in Barcelona was aimed at assessing the effect of a continuous intervention focused on C-reactive protein (CRP) rapid testing and training in enhanced communication skills (ECS) on antibiotic consumption for adults with acute cough due to lower respiratory tract infection (LRTI). The interventions consisted of general practitioners and nurses' use of CRP point-of-care and training in ECS separately and combined, and usual care. The primary outcomes were antibiotic consumption and variation of the quality-adjusted life years during a 6-week follow-up. The difference in the overall antibiotic prescribing between the winter seasons before and after the intervention was calculated. The sample size calculated could not be reached due to the COVID-19 outbreak. A total of 233 patients were recruited. Compared to the usual care group (56.7%) antibiotic consumption among patients assigned to professionals in the ECS group was significantly lower (33.9%, adjusted odds ratio [aOR] 0.38, 95% CI 0.15-0.94, p = 0.037), whereas patients assigned to CRP consumed 43.8% of antibiotics (aOR 0.70, 95% CI 0.29-1.68, p = 0.429) and 38.4% in the combined intervention group (aOR 0.45, 95% CI, 0.17-1.21; p = 0.112). The overall antibiotic prescribing rates in the centres receiving training were lower after the intervention compared to those assigned to usual care, with significant reductions in β-lactam rates. Patient recovery was similar in all groups. Despite the limited power due to the low number of patients included, we observed that continuous training achieved reductions in antibiotic consumption., (© 2024. The Author(s).)

The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged ≥15 years with a continued SO prescription for ≥3 months during 2013-2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications.

Objective: In Catalonia, the variety of the provision of Primary Healthcare has sparked intense debates over the last 20 years regarding the efficiency of the various management models. Our study analyzed the differences in the three existing management models of primary healthcare in Catalonia (the Catalan Health Institute, public consortiums and associative base entities)., Methods: The primary data were obtained from the reports of the Results Center of The Observatory of the Health System of Catalonia. Representative indicators were selected and compared with the Kruskall-Wallis test. They were later adjusted for confounding factors., Results: There were differences in the average number of visits per population attended, the percentage of the population attended in the subgroup of population over 75 years of age, the percentage of patients over 74 years with more than twelve appointments, the rate of potentially avoidable hospitalizations (total and in the subgroup of patients with chronic obstructive pulmonary disease (COPD)), polypharmacy, the use of lipid-lowering drugs and the detection of prostate-specific antigen (PSA). When adjusting for confounding variables, the differences disappeared in all of them except for the indicator on the detection of PSA., Conclusions: The differences favoured mainly the associative base entities disappear when they are corrected for confounding variables. The legal status of each provider does not significantly influence the health outcomes.

Background: In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community., Aim: To determine clinical factors of a poor prognosis in patients with COVID-19 infection., Design and Setting: Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000., Method: Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization., Results: We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex., Conclusion: Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts., Competing Interests: The authors have declared that no competing interests exist.

Objective: Indicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined IC., Methods: A prospective interventional study was conducted in 2015 in three PHC centres in Barcelona to assess the number of HIV test requests made during the implementation of an electronic prompt. Patients aged 18-65 years without HIV infection and with a new diagnosis of predefined IC were included. The results were compared with preprompt (2013) and postprompt data (2016)., Results: During the prompt period, 832 patients presented an IC (median age 41.6 years [IQR 30-54], 48.2% female). HIV tests were requested in 296 individuals (35, 6%) and blood tests made in 238. Four HIV infections were diagnosed (positivity rate 1.7%, 95% CI 0.5% to 4.4%). The number of HIV tests requested based on IC increased from 12.6% in 2013 to 35.6% in 2015 (p<0.001) and fell to 17.9% after removal of the prompt in 2016 (p<0.001). Younger patient age (OR 0.97, 95% CI 0.96 to 0.98), birth outside Spain (OR 1.53, 95% CI 1.06 to 2.21) and younger physician age (OR 0.97, 95% CI 0.96 to 0.99) were independent predictive factors for an HIV test request during the prompt period. The electronic prompt (OR 3.36, 95% CI 2.70 to 4.18) was the factor most closely associated with HIV test requests. It was estimated that 10 (95% CI 3.0 to 26.2) additional new cases would have been diagnosed if an HIV test had been performed in all patients presenting an IC., Conclusions: A significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To evaluate comorbidity, complexity and poor outcomes in patients with sarcoidosis and to compare those scores with a control group., Methods: 218 consecutive patients were diagnosed with sarcoidosis according to the ATS/ERS/WASOG criteria; extrathoracic involvement was evaluated using the 2014 WASOG organ assessment instrument. Sarcoidosis patients were compared with an age- and gender-matched control group of primary care outpatients without sarcoidosis. Comorbidities were assessed retrospectively using the Charlson Comorbidity Index (CCI); complexity was evaluated according to the classification into Clinical Risk Groups (CRG) and severity levels., Results: The cohort included 142 women and 76 men; the mean age was 47.1 years at diagnosis of sarcoidosis and 55.9 years at the last visit. Patients with a CCI > 1 had a higher frequency of calcium/vitamin D abnormalities (p < 0.001), kidney involvement (p = 0.005) and a higher mortality rate (p < 0.001) compared with patients with a CCI ≤ 1. Patients with a CRG ≥ 6 had a higher frequency of extrathoracic involvement (p = 0.039), calcium/vitamin D abnormalities (p = 0.019) and treatment with glucocorticoids (p = 0.032) compared with patients with a CRG < 6. 11% patients died after a mean follow-up of 102.3 months. Country of birth, kidney involvement and extrathoracic disease were significantly associated with death. Patients with sarcoidosis had a higher frequency of liver (p < 0.001), pulmonary (p = 0.002) and autoimmune disease (p = 0.011) and cancer (p = 0.007) compared with the control group., Conclusion: We found higher rates of comorbidity and complexity in patients with sarcoidosis compared with a control group. Liver, pulmonary, autoimmune and neoplastic diseases were the main comorbidities found in patients with sarcoidosis.

Background: Secreted frizzled-related protein 5 (SFRP5) has been linked to obesity. Results are conflicting regarding its association with type 2 diabetes (T2D) in humans. We aimed to investigate circulating SFRP5 in prediabetes and T2D and its potential association with parameters of insulin resistance and beta-cell function., Methods: We studied 70 drug-naïve T2D patients, 70 prediabetic subjects and 70 controls. All subjects were body mass index matched to the T2D patients and overweight or obese. SFRP5, hormones and cytokines levels were measured by ELISA., Results: Serum SFRP5 levels were elevated in T2D patients as compared with prediabetic subjects (median 15.6, interquartile range [9-24.5] ng/mL vs 9.8 [5-14.2] ng/mL, p < 0.001, respectively) and controls (15.6 [9-24.5] ng/mL vs 10.4 [6.7-16.6] ng/mL, P < 0.001, respectively). No differences were found in serum SFRP5 levels between prediabetic subjects and controls (9.8 [5-14.2] ng/mL vs 10.4 [6.7-16.6] ng/mL, p = 0.472, respectively). After adjusting for potential confounders (age, gender, body mass index, triglycerides, high-density lipoprotein cholesterol and blood pressure), T2D was still associated with higher values of SFRP5 as compared with prediabetes in multinomial logistic regression analysis (fully adjusted odds ratio 3.50, 95% confidence interval 1.40-8.79, p = 0.008). The association was more subtle when comparing T2D with normal glucose tolerance state (fully adjusted odds ratio 2.18, 95% confidence interval 0.91-5.21, p = 0.078)., Conclusions: Circulating SFRP5 levels were independently associated with T2D as compared with prediabetes and normal glucose tolerance state., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: Assessing ethical endorsement is crucial to the study of professional performance and moral conduct. There are no specific instruments that verify patients and professional experiences of ethical practice in the specific area of primary health care (PHC)., Objective: To study the psychometric properties of two questionnaires to identify professional and patient endorsement of normative ethics., Methods: A methodological study conducted in PHC centres from an urban area (Barcelona). A group of items from an ethical code were generated using a qualitative study with focus groups. Items underwent expert validation, item refinement and test-retest reliability. Two groups of items for PHC professionals and patients were validated. The structure of the constructs and the internal consistency were studied after participants completed the questionnaires. Principal component analysis with supplementary variables showed the utility of the validated questionnaires., Results: The patients' questionnaire consisted of 17 general items plus 11 additional items on specific conditions, and the health professional's contained 24 general and 9 specific items. The construct of the questionnaires comprised a three-factor solution for patients and a five-factor solution for professionals. Principal component analysis with supplementary variables showed that patients with higher scores on ethical perception were associated with better opinions on health care quality and more confidence in professionals. In PHC professionals, higher scores were associated with effective knowledge of the code., Conclusions: Both questionnaires showed good psychometric properties and are valid to screen ethical attitudes. The instrument warrants further testing and use with culturally diverse patients and PHC professionals.

Objectives: To characterise patients diagnosed with fibromyalgia (FM) who present a clinical profile suggestive of simulation., Methods: Observational case-control study of 218 patients who met the classification criteria for FM. The profile supporting simulation was based on the proposed criteria for evaluating disability related to the simulation of pain., Results: Compared with controls (n=105), patients with suspected simulation of FM (n=106) had a higher mean age (52.5 vs. 49.2 years, p=0.003), a higher frequency of primary education (88.7% vs. 58.1%; p<0.001), a higher percentage of separated/widowed persons (33.9% vs. 8.6%, p<0.001), a higher frequency of psychiatric disorders (100% vs. 67.6%, p<0.001), a higher mean number of positive 'control' tender points (4.5 vs. 1.3, p<0.001), a higher mean FIQ questionnaire score (89.8 vs. 68.8, p<0.001) and a lower mean LHS questionnaire score (41.0 vs. 59.9, p<0.001). Patients with suspected simulation were able to walk a shorter distance in the 6-minute walk test than controls (231.0 vs. 356.3 metres, p<0.001), while the appearance of allodynia was achieved with a significantly lower mmHg pressure (159.8 vs. 229.9 mm Hg, p<0.001)., Conclusions: Some physical/functional tests, together with the administration of specific questionnaires, may identify a subgroup of patients with FM with a profile consistent with simulation or malingering; these patients have a differentiated demographic and psychiatric profile in comparison with FM patients without a profile of simulation.

The world population is making older increasing the sanitary resources consum. It makes the elderly patients are the main occupant of hospitalary beds, who generate more mortality, longer stays and more number of readmissions. Also they are who visit more the primary health care doctor and they are the first and the most numerous drugs consumer. The result rise the medical assistance demand in the different primary health care services. The chronic diseases that older patients suffer multiply in keeping with the age, existing one significative association between many chronic diseases and the urgences admissions in the older patients. To offer the necessary service, we must improve the primary health care centers autosufficiency, the resolutive capacity and the human resources management in agreement with the needs of each moment.