[COVID-19 and functional dependence: cohort study of an outbreak in a nursing home for elderly.]

OBJECTIVE

Older people have been severely affected by the COVID-19 pandemic. The aim of this study was to describe the main epidemiological findings of a COVID-19 outbreak occurred in March 2020 at a nursing home for elderly in Granada. Risk factors associated with the spread of the virus in the center were investigated.

METHODS

A retrospective cohort study was conducted, collecting the most relevant clinical and epidemiological findings, occurred during the outbreak follow-up period (from 03/13/2020 to 06/20/2020). The association between the residents' health conditions (underlying diseases, level of physical dependence, level of cognitive impairment) and the risk of infection was estimated using multivariate Cox regression.

RESULTS

52 PCR-confirmed COVID-19 cases were identified among the residents and 50 cases among the employees of the nursing home. The epidemic curve was characteristic of a person to person transmission. Among residents with a higher level of physical dependence, according to the Barthel index score, a higher incidence of infection was detected, adjusting for age, sex and health conditions. At 55 days of exposure, moderately (RR 2.82), severely (RR 4.71) and completely (RR 3.49) dependent residents had between 2-4 times greater risk of infection than the minimally dependent residents (p<0.05).

CONCLUSIONS

The epidemic curve supports the hypothesis of a cross-transmission of infections between residents and staff members of the nursing home. In the context of sustained transmission of the virus, physical dependence of the residents increases the risk of exposure to the virus, facilitating its spreading.

Evidence for deprescription in primary care through an umbrella review

BACKGROUND

There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals.

METHODS

We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis.

RESULTS

In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process.

CONCLUSIONS

Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.

Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level

OBJECTIVE

To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level.

METHODS

12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted.

RESULTS

The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference.

CONCLUSIONS

In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

[Accessibility of web sites on health for the elderly]

BACKGROUND

The development and dissemination of the Internet offers new opportunities to meet the needs of older people. To develop this potential, access to the available resources must be guaranteed. Our aims are: (1) To identify web sites in Spanish with information on healthcare for older adults and (2) to assess the accessibility of the web sites selected.

INSTRUMENTS AND METHODS

We performed a descriptive study of compliance with accessibility criteria among web sites on healthcare for the elderly. To select the sites with health information aimed at older people, a search method with keywords was used in two of the major Internet search engines. The descriptive study was carried out by using a specially-designed questionnaire. The web sites were independently evaluated by three evaluators. The dimensions studied were visual, motor, cognitive, auditory and global factors. Accessibility A, AA and AAA was evaluated with the TAW test. A descriptive analysis of compliance was carried out and the kappa coefficient was estimated to evaluate the concordance between evaluators (Fleiss' criteria), while the number of errors was calculated according to the TAW criteria.

RESULTS

A list of 35 web sites was created. Most of the web sites had a Spanish web hosting provider (74.3%), two sites were from United States (5.7%) and the remainder were from Latin America (Cuba 1, Argentina 2, Mexico 2 and Uruguay 1). A high degree of accessibility was found for the IMSERSO Portal, the Disc@PNET portal, the section on public health protection of the Spanish Ministry of Health web site and the Community of Madrid web site. Fourteen web sites complied with more than 42% of the items evaluated. The dimension with the lowest compliance was cognitive features. When the TAW tool was applied, only the IMSERSO web site fulfilled all the criteria A, AA and AAA.

CONCLUSIONS

The present study obtained a accessibility ranking of web sites with information on health for seniors. Accessibility level varied among these web sites.

[Assessment of websites with information on medicines]

AIMS

To identify websites with information on medicines and assess, using experts, their adherence to codes of conduct and recommendations by the WHO.

DESIGN

Cross-sectional study based on an ad hoc designed questionnaire (performed independently by 2 reviewers). The websites were identified by the Delphi technique (35 experts).

SETTING

Websites with information on medicines.

PARTICIPANTS

A total of 35 websites selected by the Delphi technique. An acceptable level of stability was achieved in the third round (interquartile variability; <0.05).

MAIN MEASUREMENTS

Responsibility, transparency and honesty, authorship of the information, content review policy, privacy and data protection policies, updated information and accessibility. A descriptive analysis of compliance was carried out and the kappa coefficient was estimated to evaluate the agreement between assessors (Fleiss's Criteria).

RESULTS

The National Prescribing Service Limited (NPS), PubMed, British Medical Journal, New England Journal of Medicine, Journal of American Medical Association, The Lancet, Fisterra and National Institute for Health and Clinical Excellence stood out with an overall high fulfilment of the questionnaire. The updated information dimension was the lowest evaluation for the different websites.

CONCLUSIONS

The quality of the web sites evaluated varied widely. Although there are several websites, which are detailed in the article, with high overall scores.

Adecuación a los códigos de conducta para información biomédica en internet de sitios web útiles para el seguimiento farmacoterapéutico

OBJECTIVES

To assess adherence to four codes of conduct in websites providing information useful for pharmacotherapy follow-up.

METHODS

We performed a descriptive study of adherence to quality criteria in 19 websites. These sites had been identified in a previous study as being those most frequently used by pharmacists. A descriptive analysis was performed and the kappa coefficient was calculated to evaluate interrater concordance (Fleiss' criteria for evaluation of the kappa index).

RESULTS

The most highly rated source of clinical practice guidelines and that which adhered most closely to the 4 codes of conduct was Fisterra. The websites most highly rated in reviews and secondary sources were the Cochrane Library and PubMed. The most highly rated journals were JAMA and the BMJ, followed by Atención Primaria and Medicina Clínica. Among drug information guides, the highest scores were obtained by BOT and Martindale's. The highest rated drug bulletins were the Boletín Terapéutico Andaluz and Butlletí Groc. The most highly rated agency was the World Health Organization. The journals with the lowest scores were Pharmaceutical Care and Seguimiento Farmacoterapéutico followed by the Spanish Internacional Vademecum MediMedia-Medicom. According to Fleiss's criteria, interrater concordance was acceptable for the 4 codes.

CONCLUSIONS

The quality of the web sites evaluated varied widely, although most received scores of more than 60 points (out of 100) in the 4 codes of conduct used for evaluation.