The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain.

ObjectiveIndicator 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.MethodsA 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).ResultsDuring 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.ConclusionsA 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.

The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain. Objective: To evaluate the efficiency of an outpatient nephrology program (ONP) implanted progressively over the course of 10 years regarding the demand for CKD care in the Integral Health Area of Barcelona Esquerra, accounting for 524,395 inhabitants, which is more than a third of the population of Barcelona. Material and methods: The number and age of the new referrals to nephrology between 2004 and 2014 were identified and a referral index (RI) was established between the number of new referrals and the estimated prevalence of CKD in the population treated, based on the implementation of the ONP. Results: The adult population decreased between 2006 and 2014, but the number of inhabitants aged 65 years or above increased from 107,025 to 113,461 and so did the estimated CKD. Renal insufficiency was the reason for more than 70% of the referrals made to nephrology. The average age was 74 years old between 2004-2009 and 70 between 2010-2014. The RI showed two trends in the analysed period, depending on whether or not the ONP included the face-to-face consultancy. Conclusions: The decrease in RI suggests a better resolution at primary care. The major improvement in the Basic Health Areas of reference (with RI reduced by more than 44%) coincides with the implementation of the ONP. The implantation of ONP overcome the gap between primary and hospital care in order to respond to chronicity, aging and dependence. (C) 2018 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Nefrologia.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Introduction: Antiretroviral therapy (cART) has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. In addition, the profile of HIV infected patients is changing to an elderly population with increasing morbidities. This clinical scenario requires a new approach to coordinate the care between health teams responsible for the care of patients. To promote communication, cooperation and optimize the control of HIV infected patients, a multidisciplinary unit called Shared Care Unit (UCC) was created in 2008 among the Hospital Clinic of Barcelona and four primary care centers (CAP). In this unit, doctors and nurses from Primary Care settings and The Infectious Diseases Department from the Hospital, meet each two months to coordinate activities involving teaching, research and assistance in the field of HIV infection. We present now the results of a pilot study undertaken in 2013 for evaluating the shared care unit for HIV stable patients.Objectives: To compare the HIV standard of care (controls) with the care in UCC (cases).Methods: A pilot prospective case-control study with duration of 1.5 years was performed in the Hospital Clinic and three CAPs of the same health district.Inclusion criteria for cases were stable patients (Chronic HIV infection with CD4 above 350 cells/mm3 during the last 6 months and if on ART with an undetectable viral load). Exclusion criteria were HIV-infected adults with current therapeutic failure (defined by detectable viral load on cART or CD4 cell count below 250 cells/mm3), tumours, opportunistic infections, or pregnant women.Control patients were HIV infected patients matched for age, sex, primary care center, use of cART and undetectable viral load at the date of inclusion in the study.HIV care during the 18 months of follow-up was performed in control patients as usual in hospital (3 visits), whilst cases made two visits in CAP and the last one in the Hospital.Variables regarding clinical performance [HIV clinical parameters (CD4 cell count, viral load, opportunistic infections, death] and cART-compliance were evaluated throughout the study follow-up. Adherence was estimated at each clinical consultation by monitoring pharmacy refills and through self-reports and was considered high if the patients take more than 90% of the scheduled medication. Quality of life was evaluated through a questionnaire that has been validated in HIV patients (Mini International Neuropsychiatric Interview (MINI). Psychological and emotional Impact was evaluated using several validated screening questionnaires: the Hospital Anxiety and Depression (HAD) Scale to measure anxiety and depression. A qualitative statement about health services utilization in the study population was registered as well as acceptability and satisfaction with the type or care.Results: 93 patients (31 cases and 62 control patients) were included. The mean age of patients was 42 years, 86% were men, 81% men who have sex with men (MSM) and 29% were foreigners. The CD4 count, viral load and adherence to ART showed no significant differences in both groups. Quality of life, psychosocial assessment, the number of emergency room visits and other specialists was similar in cases and controls. 85% liked UCC and 93% considered in the future continue to use the UCC.Conclusions: A Shared Care Unit of HIV infection between Hospital and Primary Care Centers is possible and in this pilot study has been a safe tool for the clinical management of stable HIV infected patients. Sharing clinical management of stable HIV infection between Hospitals and Primary care centers might be an additional model of care.

Introduction A new model of integrated care was established in our hospital since 2008, in which hospital specialists attend patients in different primary care centers. We assessed the impact of this model in the respiratory diseases management.Methods Retrospective, observational study comparing 2 care models in the same cohort of patients: conventional (prior model of care by pulmonologists not integrated into primary care teams) and integrated. Different clinical outcomes were analyzed in relation to the management of respiratory diseases.Results We evaluated 545 patients consecutively attended during a period of 6 months, in five primary care centers. The diagnoses that were established after the start of the new model were: COPD (30 %), bronchial asthma (32%), OSAS (7%), bronchiectasis (15 %), chronic cough (1%) and others (25%). The number of registered spirometries increased after the beginning of the new care model (19 % to 68 %, p < 0.001). A change in diagnoses and treatments occurred in 21% and 49% of cases respectively after initiating the new model. After assessing consultations for exacerbations in a period of 2 years before and after the application of the new model , a significant overall reduction in the number of consultations for exacerbation per patient was observed: 1.07 ± 1.40 to 0.88 ± 1.25 (p=0.001).Conclusions The implementation of a respiratory care model integrated into primary care improved the follow up of these patients by reducing the overall number of visits for exacerbations, possibly due to the optimization of the diagnosis and treatment.Funded by: Atencio Integral de Salut de Barcelona Esquerra.

Evaluar el impacto de un programa de integración entre cardiología y atención primaria en la práctica clínica, comparado con la atención convencional. La integración consiste en un cardiólogo hospitalario en cada centro de atención primaria, historia clínica común, guías clínicas consensuadas, sesiones de consultoría y otras herramientas de coordinación. Estudio observacional de dos muestras transversales sobre prevalencias en periodos antes y después de la intervención: atención convencional y atención integrada. Se analiza: distribución de pacientes atendidos, impacto en indicadores de buena práctica clínica en los pacientes con cardiopatía isquémica, insuficiencia cardiaca y fibrilación auricular, satisfacción de atención primaria y uso de recursos. Se incluyó a 3.194 pacientes (1.572 en atención convencional y 1.622 en integrada). La integración redistribuyó a los pacientes y aumentó el control del cardiólogo sobre enfermedades graves y el control desde primaria de los factores de riesgo y pacientes estables. En cardiopatía isquémica, mejoró el control de colesterolemia, presión arterial, optimización del tratamiento y documentación de la función ventricular. En insuficiencia cardiaca, aumentó el tratamiento con bloqueadores beta y la valoración funcional. En fibrilación auricular, mejoró el estudio con ecocardiografía e indicación de anticoagulación. El uso de recursos no aumentó. La satisfacción de los médicos de primaria se incrementó con la integración. Tras la integración, mejoró el control y el tratamiento crónico de los pacientes con cardiopatía isquémica, insuficiencia cardiaca y fibrilación auricular, se redistribuyó a los pacientes crónicos entre atención primaria y cardiología, y aumentó la satisfacción de los médicos de familia, sin objetivarse incremento en el uso de recursos. To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools. Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources. We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, β-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased. Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians' satisfaction levels improved. There was no increase in use of resources. Full English text available from: www.revespcardiol.org

Introduction and objectives: To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools.Methods: Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources.Results: We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, beta-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased.Conclusions: Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians' satisfaction levels improved. There was no increase in use of resources. (C) 2011 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.