Intervention to reduce perceived loneliness in community-dwelling older people.

Aim: We evaluated the reduction in perceived loneliness and depression and the increase in social support and quality of life in community-dwelling lonely people aged >65 years included in a community intervention compared with nonlonely controls from the same urban area.

Design: Randomised clinical trial without blind evaluation.

Location: Urban area of Barcelona.

[Profiles of loneliness and social isolation in urban population].

Objective: To assess the prevalence of loneliness and social isolation in a population over 65 cared by a urban primary health team and to identify its main characteristics.

Design: Cross-sectional descriptive study by a telephone survey.

Setting: Basic health area of Barcelona.

Effects of undocumented immigrants exclusion from health care coverage in Spain.

Background: In 2012 the Spanish government passed Royal Decree-Law 16/2012 (RDL) aimed at containing public expenditure in response to the economic crisis. This RDL redefined just who would be entitled to public health care. As a result, a large proportion of undocumented immigrants in Spain were excluded from basic publicly financed health care with access only being granted under particular circumstances (emergency care, maternal care, children under 18, asylum seekers and victims of human trafficking).

Randomized trial to reduce emergency visits or hospital admissions using telephone coaching to complex patients.

Background: Comorbidity remains a matter of international interest, given growing prevalence of chronic conditions.

Objective: To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing resource consumption and improving health status, caregiver burden and quality of life among complex chronic patients (CCP) compared with usual care.

Methods: A randomized controlled trial was conducted on a random sample of CCP from three primary care teams in Barcelona.

[Social isolation and loneliness: What can we do as Primary Care teams?].

Loneliness and social isolation are emerging health conditions in the elderly population, in particular widows, high frequency users of health services and those with chronic problems and depression. Loneliness is the subjective feeling of having less affection and closeness than that desired in the intimate or relational field. Social isolation is an objective situation of having minimal contact with other people.

The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms.

Objective: To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG).

Methods: Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG.

Cuts drive health system reforms in Spain.

The economic crisis is largely shaping health policy in Spain. This paper reports on major changes in the health care system, both nationally and regionally, as a consequence of sizable cutbacks and new pieces of legislation. The most relevant changes to the system introduced during the last year are having an impact on who is insured, which benefits are covered, and what share of the cost of service provision is contributed by the population, while at the same time reducing salaries and working conditions in the sector.

Predictors of mortality among elderly dependent home care patients.

Background: The purpose of this study is to identify which variables--among those commonly available and used in the primary care setting--best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program.

Methods: A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs.

Forumclínic: the shaping of virtual communities to assist patients with chronic diseases.

Information and communication technologies (ICTs) provide new opportunities to complement traditional care while enhancing patient autonomy. With the objective to supplement patient care, a group of health professionals at the Hospital Clínic de Barcelona created Forumclínic, an online networking website in Spanish and Catalan. In 2008, seven web- and DVD-based chronic disease portals (Diabetes, Schizophrenia, Cardiac Ischemia, COPD, Depression, Breast Cancer and cardiovascular risk) were created with the following resources: multimedia patient education material; physician-specialist transcribed research (articles) news; an open question forum (for clinician-user and user-to-user interaction); and patient and specialist interview videos on the progress of disease, common diagnosis and treatment procedures; and information on the best or worst prognoses.

[Factors associated with hospitalization in a cohort of elderly patients included in a home care program].

Background And Objective: The objective is to identify the features associated with next year hospital admissions among elderly dependent patients living at home (EDLH) and visited by primary care teams at their home setting.

Patients And Method: Longitudinal cohort study of a sample of EDLH patients admitted to a home care programme delivered by 72 primary care teams. A global health assessment was performed at recruitment in all patients (health and social status, informal and formal carer characteristics and burden of care).

Spanish health care cuts: penny wise and pound foolish?

The purpose of this paper is to convey the specific health care actions and policies undertaken by the Spanish government, as well as by regional governments, as a result of the economic crisis. Throughout the last two years we have witnessed a number of actions in areas such as human capital, activity and processes, outsourcing and investment that, poorly coordinated, have shaped the nature of financial cuts on public services. This paper discloses the size and magnitude of these actions, the main actors involved and the major consequences for the health sector, citizens and patients.

[The reform of primary care, between the last refuge of adventure and innovation. SESPAS report 2012].

Primary care reforms started thirty years ago, but not fully developed their potential. Improvements should be suggested to be accompanied by adequate funding, operational capacity and organization and clinical skills adapt to upgrading and trivialized demand, bureaucracy and medicalization. Organizational-suggested reforms have not shown conclusive differences yet.

Nursing workload predictors in Catalonia (Spain): a home care cohort study.

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.