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This study endeavors to ascertain the cost-effectiveness and utility of employing SAPs in comparison to foam dressings for the management of moderate-to-highly exuding leg ulcers within Spanish healthcare contexts. Furthermore, it aims to conduct an associated budget-impact analysis for the Spanish National Health Service, thereby considering the financial implications relevant to the implementation of these interventions. The economic evaluation and budget impact model adhered to Spanish and international guidelines. with reporting quality of economic evaluation assessed using the CHEERS checklist and the Drummond checklist for ensuring adequate conduct. The evidence synthesis process involved identifying and appraising the most recent and highest level of evidence research. The identified data inputs were adjusted in accordance with recommended practices for research quality and incorporated into a mathematical model that accounted for the natural history of chronic leg ulcers. Based on the results of this preliminary health economic analysis, utilizing SAP wound dressings instead of foam dressings in patients with moderate-to-highly exuding leg ulcers within the Spanish Health Care System is projected to yield favorable outcomes. The analysis predicts an enhanced healing rate of 2.33%, an incremental improvement in health-related quality of life (HRQoL) by 0.129 quality-adjusted life weeks (QALWs), and a total direct cost reduction of 570 Euros per patient over a six-month period. Extrapolating these findings to a scenario where all leg ulcers are treated with SAPs rather than foam dressings, the Spanish NHS could potentially achieve an annual cost savings of 43.46 million of Euros. These clinical outcomes align with current treatment guidelines that advocate for superabsorbent wound dressings as the primary choice for managing moderate-to-highly exuding leg ulcers.

Primary care (PC) professionals have been considered the most appropriate practitioners for leading Advance care planning (ACP) processes with advanced chronic patients. Aim: To explore how PC doctors’ and nurses’ self-efficacy surrounding ACP is linked to their sociodemographic characteristics, background and perceptions of ACP practices. Methods: A cross-sectional study was performed. Sociodemographics, background and perceptions about ACP in practice were collected using an online survey. The Advance Care Planning Self-Efficacy Spanish (ACP-SEs) scale was used for the self-efficacy measurement. Statistical analysis: Bivariate, multivariate and backward stepwise logistic regression analyses were performed to identify variables independently related to a higher score on the ACP-SEs. Results: N = 465 participants, 70.04% doctors, 81.47% female. The participants had a mean age of 46.45 years and 66.16% had spent >15 years in their current practice. The logistic regression model showed that scoring ≤ 75 on the ACP-SEs was related to a higher score on feeling sufficiently trained, having participated in ACP processes, perceiving that ACP facilitates knowledge of preferences and values, and perceiving that ACP improves patients’ quality of life. Conclusion: Professionals with previous background and those who have a positive perception of ACP are more likely to feel able to carry out ACP processes with patients. Keywords: advance care planning; primary care; self-efficacy publishedVersion

The aim of the research is to assess the benefit–harm of superabsorbent polymers wound dressings based on polyacrylate polymers (SAPs) compared with standard of care (SoC) dressing mix for patients with moderate-to-highly exuding hard-to-heal leg ulcers. The SoC dressings mix was composed of other superabsorbents in 29% of cases, antimicrobials 26%, foams 20%, alginates 5%, and other dressings 19% weighted according to their frequency. We have used the decision-analytic modeling method, Markov process, as an adequate analytical solution for medical prognosis. We have combined the systematic literature search to identify the most relevant inputs for the analysis, with available patient-level clinical data concerning benefits of superabsorbent to generate a robust prediction of patient-relevant outcomes, including healing rates and health-related quality of life. Besides, we have qualitatively described adverse events associated with those treatments. Our research indicates that SAPs when compared with SoC dressing mix in a patient with moderate-to-highly excluding leg ulcers are leading to an improved healing rate with an absolute risk difference of 2.20% in 6 months and a relative risk of 1.07 in favor of SAP dressings. The attributable fraction among those exposed to SAP dressings of 6.6%, meaning that 6.6% of the healed ulcers could be attributed to having had the SAP dressing treatment instead of the SoC dressing treatment. Besides, SAP dressings lead to improved quality of life measured as incremental quality-adjusted life weeks (QALWs) of 0.13 QALWs.

Background Frailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models. Methods A prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005–2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at 8 years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine–Gray regression models were used. Results At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program. Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk. Conclusions Prognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.

Background The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥ 70 years in home care programmes (HC) or nursing homes (NH) and to develop the corresponding prediction models. Methods Study design: Prospective, multicentre, cohort study in 23 primary health care centres located in Catalonia, Spain, with an eight-year follow-up (2005-2013). Participants: the cohort was made up of 616 individuals. Data collection: Baseline interview included a multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic health care records, telephone contacts, and the Central Registry of Catalonia for mortality. Statistical analysis: A prognostic index for HC and NH at eight years was estimated for each patient. Death prior to these events was considered as a competing risk event, and Fine–Gray regression models were used. The internal validity of the predictive models was tested for 150 bootstrap re-samples.Results At baseline, mean age was 76.4 years, 55.5% were women, and 22% lived alone. During follow-up, 19.2% entered an HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in an HC program. Multivariate competitive risk models for HC and NH showed that the risk of HC entry was associated with older age, dependence on the Instrumental Activities of the Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of the Daily Living, augmented number of prescriptions, and the presence of social risk. Conclusions Prognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of the elderly in the primary healthcare centres. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.

ObjetivoBuscar oportunidades de mejora mediante la evaluación de la atención domiciliaria que ofrecen los equipos de atención primaria en nuestro entorno a las personas > 65 años de edad con enfermedades crónicas. Identificar cuáles son las variables del paciente y del servicio que recibe que se asocian con el deterioro funcional y cognitivo, ingreso en una residencia geriátrica, visita a urgencias, ingreso hospitalario o muerte.DiseñoEstudio analítico de seguimiento de una cohorte durante 3 años.EmplazamientoEquipos de atención primaria de Cataluña.ParticipantesEn total, 1.300 pacientes > 65 años con enfermedades crónicas incluidos en el Programa de Atención Domiciliaria.Mediciones principalesSe recoge anualmente su estado de salud (Charlson, Barthel, Pfeiffer, Braden y Gijón), datos sobre el cuidador (Zarit), atenciones recibidas (social y sanitaria), salud subjetiva (SF-12), visitas a urgencias, ingresos temporales y el resultado final: muerte, ingreso en residencies geriátricas u hospital. Los análisis principales se basarán en regresiones logísticas y una análisis de supervivencia.DiscusiónEl estudio permitirá identificar las características del paciente que tengan valor pronóstico, así como conocer las prácticas de atención social y sanitaria que se asocian con una mejor supervivencia y un menor consumo de recursos sociosanitarios.ObjectivesTo evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities.To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death.DesignAnalytic study of the follow-up of a cohort for 3 years.SettingPrimary health care teams in Catalonia, Spain.PatientsOne thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia.Main measurementsThe following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis.ConclusionsThe study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources.

ResumenObjetivoidentificar las variables relacionadas con el hecho de recibir servicios sociales de carácter público o privado antes de la implantación de la Ley de Dependencia en pacientes recluidos en sus domicilios.Diseñoestudio descriptivo transversal.Emplazamiento72 equipos de atención primaria de Cataluña (EAP).Participantespacientes mayores de 64 años, no institucionalizados atendidos por un programa de atención domiciliaria de los EAP.Mediciones principalesde cada paciente se registraron: comorbilidad, estado funcional, estado cognitivo, si tenía úlceras por presión, salud subjetiva, valoración social, utilización de servicios sociales y sanitarios formales e informales, sobrecarga del cuidador, ingresos en residencias, hospitales o urgencias, además del número de visitas de profesionales santiarios.Resultadosparticipan 1.068 pacientes, el 46,8% recibe algún servicio social. Las variables relacionadas con la prestación de servicios sociales son: el grado de dependencia (Barthel), las úlceras por presión y recibir rehabilitación a domicilio. El test de Barthel está firmemente asociado a la problemática social (Gijón), carecer de cuidador informal, más de dos visitas de médico de familia y tener sanidad privada adicional.Conclusionespara ser más equitativa, la valoración de las prestaciones de la Ley de Dependencia debería considerar también el estado de salud. Antes de la aplicación de esta ley se intuye una dificultad de acceso a los servicios sociales formales para las clases medias que no acceden a las prestaciones públicas ni pueden pagarlas. Las prestaciones sociales son todavía una alternativa a la atención familiar.AbstractObjectiveTo identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law.DesignCross-sectional study.Setting72 primary health care teams in Catalonia.PatientsPatients over 64 years old with chronic diseases in home care programmes in Catalonia.MeasurementsHealth status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital.ResultsA total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care.ConclusionsTo be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care.

OBJECTIVES: To evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities.To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death. DESIGN: Analytic study of the follow-up of a cohort for 3 years. SETTING: Primary health care teams in Catalonia, Spain. PATIENTS: One thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia. MAIN MEASUREMENTS: The following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis. CONCLUSIONS: The study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources.

Resumen: Introducción: La seguridad de los pacientes representa una prioridad del sistema de salud y un principio fundamental de la atención sanitaria. Las úlceras por presión, evitables en un alto porcentaje, son consideradas el primer evento adverso relacionado con los cuidados de enfermería. Objetivos: Conocer la percepción de los distintos profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso. Metodología: Se realizó un estudio descriptivo transversal en enero de 2016 a personal sanitario de diferentes centros de trabajo, principalmente de España y Andorra. Se administró una encuesta online desarrollada por los investigadores ad hoc para la recogida de datos con variables sociodemográficas, experiencia y ámbito de trabajo y los diferentes ítems en los que se pretendía conocer su opinión sobre la importancia de tres efectos adversos: úlceras por presión, caídas y flebitis. Resultados: Participaron 459 profesionales: un 71,24% enfermeras, un 14,81% médicos y un 13,95% técnicos en cuidados auxiliares en enfermería. El 87,7% consideró las úlceras por presión como un evento adverso grave, y las enfermeras fueron el colectivo que consideró este efecto como más grave. Para la prevención de estas lesiones, el 97,8% afirmaron la evidencia de su evitabilidad. No se observó asociación sobre la importancia y consecuencias de las úlceras por presión como evento adverso entre las variables profesión y opinión. Conclusiones: Los encuestados consideraron las úlceras por presión como el evento adverso más grave entre los cuidados de enfermería y consideraron, además, que se pueden prevenir.

Objective: To identify the characteristics of chronic patients and their environment in order to predict the nursing workload required 1 year after their inclusion in a home care program. Methods: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain) with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected from each patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer, Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services, self-perceived health (SF-12) and the number of health worker visits. Results: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD 13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender (IRR = 1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR = 1.65, 95%CI: 1.29-2.13), decubitus ulcers (IRR = 4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR = 1.65, 95%CI: 1.31-2.07). In contrast, patients with major cognitive impairment (IRR = 0.78, 95%CI: 0.63-0.98) had a lower probability of receiving nursing visits at home. Conclusions: Workload can be predicted by patients’ clinical characteristics. The positive correlation of workload with variables related to disease severity and the negative correlation with variables related to cognitive impairment show that home care nursing in Catalonia is basically demand-oriented.