1
|
Zhang P, Tao X, Ma Y, Zhang Y, Ma X, Song H, Liu Y, Patel A, Jan S, Peiris D. Improving the management of type 2 diabetes in China using a multifaceted digital health intervention in primary health care: the SMARTDiabetes cluster randomised controlled trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101130. [PMID: 39056088 PMCID: PMC11269311 DOI: 10.1016/j.lanwpc.2024.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/23/2024] [Accepted: 06/16/2024] [Indexed: 07/28/2024]
Abstract
Background There is limited evidence, mainly from high-income countries, that digital health interventions improve type 2 diabetes (T2DM) care. Large-scale implementation studies are lacking. Methods A multifaceted digital health intervention comprising: (1) a self-management application ('app') for patients and lay 'family health promotors' (FHPs); and (2) clinical decision support for primary care doctors was evaluated in an open-label, parallel, cluster randomized controlled trial in 80 communities (serviced by a primary care facility for >1000 residents) in Hebei Province, China. People >40 years with T2DM and a glycated haemoglobin (HbA1c) ≥7% were recruited (∼25/community). After baseline assessment, community clusters were randomly assigned to intervention or control groups (1:1) via a web-based system, stratified by locality (rural/urban). Control arm clusters received usual care without access to the digital health application or family health promoters. The primary outcome was at the participant level defined as the proportion with ≥2 "ABC" risk factor targets achieved (HbA1c < 7.0%, blood pressure < 140/80 mmHg and LDL-cholesterol < 2.6 mmol/L) at 24 months. Findings A total of 2072 people were recruited from the 80 community clusters (40 urban and 40 rural), with 1872 (90.3%) assessed at 24 months. In the intervention arm, patients used FHPs for support more in rural than urban communities (252 (48.6%) rural vs 92 (21.5%) urban, p < 0.0001). The mean monthly proportion of active app users was 46.4% (SD 7.8%) with no significant difference between urban and rural usage rates. The intervention was associated with improved ABC control rates (339 [35.9%] intervention vs 276 [29.9%] usual care; RR 1.20, 95% CI 1.02-1.40; p = 0.025), with significant heterogeneity by geography (rural 220 [42.6%] vs 158 [31.0%]; urban 119 [27.9%] vs 118 [28.6%]; p = 0.022 for interaction). Risk factor reductions were mainly driven by improved glycaemic control (mean HbA1C difference -0.33%, 95% CI -0.48 to -0.17; p = 0.00025 and mean fasting plasma glucose difference -0.58 mmol, 95% CI -0.89 to -0.27; p = 0.00013). There were no changes in blood pressure and LDL-cholesterol levels. Interpretation A multifaceted digital health intervention improved T2DM risk factor control rates, particularly in rural communities where there may be stronger relationships between patients and doctors and greater family member support. Funding National Health and Medical Research CouncilGlobal Alliance for Chronic Diseases (ID 1094712).
Collapse
Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health China, UNSW, Sydney, Australia
| | - Xuanchen Tao
- The George Institute for Global Health China, UNSW, Sydney, Australia
| | - Yuxia Ma
- Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yaosen Zhang
- Luquan Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, China
| | - Xinyan Ma
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Hongyi Song
- The George Institute for Global Health China, China
| | - Yu Liu
- Beihang University, Beijing, China
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Australia
| |
Collapse
|
2
|
Baumann S, Stone RT, Abdelall E. Introducing a Remote Patient Monitoring Usability Impact Model to Overcome Challenges. SENSORS (BASEL, SWITZERLAND) 2024; 24:3977. [PMID: 38931760 PMCID: PMC11207983 DOI: 10.3390/s24123977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Telehealth and remote patient monitoring (RPM), in particular, have been through a massive surge of adoption since 2020. This initiative has proven potential for the patient and the healthcare provider in areas such as reductions in the cost of care. While home-use medical devices or wearables have been shown to be beneficial, a literature review illustrates challenges with the data generated, driven by limited device usability. This could lead to inaccurate data when an exam is completed without clinical supervision, with the consequence that incorrect data lead to improper treatment. Upon further analysis of the existing literature, the RPM Usability Impact model is introduced. The goal is to guide researchers and device manufacturers to increase the usability of wearable and home-use medical devices in the future. The importance of this model is highlighted when the user-centered design process is integrated, which is needed to develop these types of devices to provide the proper user experience.
Collapse
Affiliation(s)
- Steffen Baumann
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA 50011, USA;
| | - Richard T. Stone
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA 50011, USA;
| | - Esraa Abdelall
- Department of Industrial Engineering, Jordan University of Science and Technology, Ar-Ramtha 3030, Jordan;
| |
Collapse
|
3
|
Vázquez-de Sebastián J, Ortiz-Zuñiga AM, Ciudin A, Ars J, Inzitari M, Simó R, Hernández C, Ariño-Blasco S, Barahona MJ, Franco M, Gironès X, Crespo-Maraver MC, Rovira JC, Castellano-Tejedor C. Cognitive Profile and Cardiovascular Risk Factors in Older Adults with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:500. [PMID: 38673411 PMCID: PMC11050679 DOI: 10.3390/ijerph21040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
The prevalence of cardiovascular risk factors (CVRFs) in the older adults population and their specific impact on their cognitive profiles still requires further research. For this purpose, a cross-sectional study was carried out to describe the presence of CVRFs and their association with cognitive performance in a sample of older adults (65-85 years old) with Mild Cognitive Impairment (MCI). Participants (n = 185) were divided into three groups concerning their cardiovascular risk level determined by the presence of different CVRFs, including Type 2 Diabetes (T2D), dyslipidemia, hypertension, and obesity. The primary outcome measures were the participant's scores in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Sociodemographic, clinical, and psychosocial data were collected. Non-parametrical statistical analyses and effect sizes were calculated. Findings revealed that a greater presence of CVRFs was not associated with a worse overall cognitive performance. High-risk patients were more likely to have significantly worse performance in the attentional domain compared to medium-risk (p = 0.029, r = 0.42) and compared to low-risk (p = 0.041, r = 0.35), specifically in the digits repetition subtest (p = 0.042). T2D alone was the CVRF associated with cognitive differences (p = 0.037, r = 0.32), possibly mediated by the duration of the condition. Consequently, a higher presence of CVRFs did not lead to a worse overall cognitive performance. However, high-risk individuals were more likely to experience cognitive impairment, particularly in the attentional domain. T2D played a significant role in these cognitive profile differences, possibly influenced by its duration.
Collapse
Affiliation(s)
- Julia Vázquez-de Sebastián
- Facultat de Psicologia, Universitat Autònoma de Barcelona (UAB), 08192 Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili (VHIR-PSPV), 08023 Barcelona, Spain (C.C.-T.)
- Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - Angel M. Ortiz-Zuñiga
- Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III Spain & Endocrinology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Andreea Ciudin
- Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III Spain & Endocrinology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Joan Ars
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili (VHIR-PSPV), 08023 Barcelona, Spain (C.C.-T.)
- Medicine Department, Universitat Autònoma de Barcelona (UAB), 08192 Bellaterra, Spain
| | - Marco Inzitari
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili (VHIR-PSPV), 08023 Barcelona, Spain (C.C.-T.)
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
| | - Rafael Simó
- Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III Spain & Endocrinology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Cristina Hernández
- Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III Spain & Endocrinology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Sergio Ariño-Blasco
- Geriatric Service, Fundació Privada Hospital Asil de Granollers (FPHAG), 08402 Barcelona, Spain
| | - María José Barahona
- Endocrinology Service, Hospital Universitari Mutua Terrassa (HUMT), 08221 Terrassa, Spain
| | - Maite Franco
- Consorci Sanitari de Terrassa (CST), 08227 Terrassa, Spain
| | - Xavier Gironès
- Faculty of Health Sciences (UM-FUB), University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | | | - Joan Carles Rovira
- Consorci Hospitalari de Vic (University Hospital of Vic), 08500 Vic, Spain
| | - Carmina Castellano-Tejedor
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili (VHIR-PSPV), 08023 Barcelona, Spain (C.C.-T.)
- GIES Research Group, Basic Psychology Department, Universitat Autònoma de Barcelona (UAB), 08192 Bellaterra, Spain
| | | |
Collapse
|
4
|
Baumann S, Stone R, Kim JYM. Introducing the Pi-CON Methodology to Overcome Usability Deficits during Remote Patient Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:2260. [PMID: 38610471 PMCID: PMC11014368 DOI: 10.3390/s24072260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
The adoption of telehealth has soared, and with that the acceptance of Remote Patient Monitoring (RPM) and virtual care. A review of the literature illustrates, however, that poor device usability can impact the generated data when using Patient-Generated Health Data (PGHD) devices, such as wearables or home use medical devices, when used outside a health facility. The Pi-CON methodology is introduced to overcome these challenges and guide the definition of user-friendly and intuitive devices in the future. Pi-CON stands for passive, continuous, and non-contact, and describes the ability to acquire health data, such as vital signs, continuously and passively with limited user interaction and without attaching any sensors to the patient. The paper highlights the advantages of Pi-CON by leveraging various sensors and techniques, such as radar, remote photoplethysmography, and infrared. It illustrates potential concerns and discusses future applications Pi-CON could be used for, including gait and fall monitoring by installing an omnipresent sensor based on the Pi-CON methodology. This would allow automatic data collection once a person is recognized, and could be extended with an integrated gateway so multiple cameras could be installed to enable data feeds to a cloud-based interface, allowing clinicians and family members to monitor patient health status remotely at any time.
Collapse
Affiliation(s)
| | | | - Joseph Yun-Ming Kim
- Industrial and Manufacturing Systems Engineering, Iowa State University, 2529 Union Dr, Ames, IA 50011, USA; (S.B.); (R.S.)
| |
Collapse
|
5
|
Härkönen H, Lakoma S, Verho A, Torkki P, Leskelä RL, Pennanen P, Laukka E, Jansson M. Impact of digital services on healthcare and social welfare: An umbrella review. Int J Nurs Stud 2024; 152:104692. [PMID: 38301306 DOI: 10.1016/j.ijnurstu.2024.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. METHODS The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. RESULTS A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management. CONCLUSIONS Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.
Collapse
Affiliation(s)
- Henna Härkönen
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland.
| | - Sanna Lakoma
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Anastasiya Verho
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Paulus Torkki
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | | | - Paula Pennanen
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Elina Laukka
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Miia Jansson
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland; RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia
| |
Collapse
|
6
|
Zamanillo-Campos R, Fiol-DeRoque MA, Serrano-Ripoll MJ, Mira-Martínez S, Llobera-Canaves J, Taltavull-Aparicio JM, Leiva-Rus A, Ripoll-Amengual J, Angullo-Martínez E, Socias-Buades IM, Masmiquel-Comas L, Konieczna J, Zaforteza-Dezcallar M, Boronat-Moreiro MA, Gervilla-García E, Ricci-Cabello I. DiabeText, a mobile health intervention to support medication taking and healthy lifestyle in adults with type 2 diabetes: Study protocol for a randomized controlled trial. Contemp Clin Trials 2024; 136:107399. [PMID: 37995967 DOI: 10.1016/j.cct.2023.107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/31/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023]
Abstract
AIM To evaluate the effectiveness of DiabeText, a low-intensity, multifaceted, mobile health (mHealth) intervention to support medication taking and lifestyle change targeted to people with type 2 diabetes (T2D). DESIGN Phase III, 12-months, two-arm (1:1 allocation ratio), randomized parallel-group trial. METHODS We will recruit 740 adults with glycated hemoglobin (A1c) >8% (>64 mmol/mol) and with at least one prescription of a non-insulin antidiabetic drug. They will be allocated to a control (usual care) group or an intervention (DiabeText messaging intervention) group. The primary outcome measure will be A1c at 12 months follow-up. Secondary outcomes will include medication possession ratio and behavioral and psychological outcomes. DISCUSSION Recent trials suggest that digital health interventions can effectively support diabetes self-management improving T2D control and reducing important T2D complications. In Spain this type of interventions is understudied. IMPACT This trial will strengthen the evidence base of the impact of mHealth interventions to support diabetes self-management. If effective, DiabeText may offer a low-cost and highly scalable strategy to improve health at the population level in a sustainable way. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05006872; Official Title: Supporting People with Type 2 Diabetes in Effective Use of their Medicine Through a System Comprising Mobile Health Technology Integrated with Clinical Care.
Collapse
Affiliation(s)
- Rocío Zamanillo-Campos
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Maria Antonia Fiol-DeRoque
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain.
| | - Maria Jesús Serrano-Ripoll
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Sofía Mira-Martínez
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Joan Llobera-Canaves
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Joana María Taltavull-Aparicio
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Alfonso Leiva-Rus
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Joana Ripoll-Amengual
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Escarlata Angullo-Martínez
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Isabel Maria Socias-Buades
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Luis Masmiquel-Comas
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Jadwiga Konieczna
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Zaforteza-Dezcallar
- Pharmacy Service, Balearic Islands Health Service, Carrer Reina Esclaramunda n° 9, 07003 Palma, Spain
| | | | - Elena Gervilla-García
- Psychology Department, University of the Balearic Islands (UIB), Palma de Mallorca, Spain; Statistical and Psychometric Procedures Applied in Health Science, University of the Balearic Islands (UIB), Palma de Mallorca, Spain
| | - Ignacio Ricci-Cabello
- Research Group on Primary Care and Promotion of the Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, University Hospital Son Espases (HUSE), Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| |
Collapse
|