Himar González‐Pacheco

Servicio Canario de la Salud

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Yolanda Ramallo‐Fariña

Red de Investigación en Actividades Preventivas y Promoción de la Salud

Amado Rivero‐Santana

Red de Investigación en Actividades Preventivas y Promoción de la Salud

Lilisbeth Perestelo‐Pérez

Servicio Canario de la Salud

Pedro Serrano‐Aguilar

Servicio Canario de la Salud

Andrea Duarte‐Díaz

Red de Investigación en Actividades Preventivas y Promoción de la Salud

YÁ

Yolanda Álvarez‐Pérez

Fundación Canaria de Investigación Sanitaria

MÁ

Miguel Ángel García Bello

Health Research Institute of the Balearic Islands

Vanesa Ramos‐García

Red de Investigación en Actividades Preventivas y Promoción de la Salud

Ana Toledo‐Chávarri

Fundación Canaria de Investigación Sanitaria

Lidia García‐Pérez

Health Research Institute of the Balearic Islands

Cooperative Institutions

Servicio Canario de la Salud

Agencia de Evaluación de Tecnologías Sanitarias

Red de Investigación en Actividades Preventivas y Promoción de la Salud

Sistema Nacional de Salud

Health Research Institute of the Balearic Islands

Universidad de La Laguna

Centro de Investigación Biomédica en Red

Fundación Canaria de Investigación Sanitaria

Instituto de Salud Carlos III

Spanish Clinical Research Network

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062 Exploring shared decision-making in diabetes: patient- observer perspectives and health outcomes

Andrea Duarte‐Díaz Himar González‐Pacheco Amado Rivero‐Santana Yolanda Ramallo‐Fariña Jorge Pérez-Robaina

Observer (physics)

Medical Decision Making

10.1136/bmjebm-2024-sdc.61

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The Effect of Patient Empowerment on Anxiety, Depression or Health-Related Quality of Life in Patients With Type 2 Diabetes: A Systematic Review Protocol

Research Square (Research Square) (2020)

Andrea Duarte‐Díaz Lilisbeth Perestelo‐Pérez Amado Rivero‐Santana Wenceslao Peñate Yolanda Álvarez‐Pérez

Abstract Background . Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent health problems worldwide. Besides metabolic and cardiovascular complications, nearly one in four patients with T2DM suffer from comorbid depression and it has been reported higher incidence and prevalence of anxiety disorders. Beyond metabolic and cardiovascular risk improvement, empowering patients could contribute to mental health and quality of life enhancement. This Systematic Review (SR) aims to analyze and synthetize the evidence about the effect of patient empowerment on anxiety, depression and health-related quality of life (HRQOL). Methods . A SR of the literature will be conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The review will include studies reporting the effect of patient empowerment on anxiety, depression or HRQOL in patients with a T2DM diagnosis. We will use the following databases: Medline, Embase, PsycInfo and Cochrane Library, from inception through July 2020. Additionally, the database searches will be supplemented by searching through citations and references. Literature searches, identification of eligible studies, data extraction, and bias assessment will be undertaken independently by at least two researchers. All disagreements will be resolved by an independent third reviewer. If heterogeneity between studies is too high or it is not possible to conduct a meta-analysis, a narrative analysis of the study results will be provided. Discussion . Existing evidence suggest that empowerment-based strategies significantly improve knowledge, anxiety and depressive levels, self-care, and motivation; contributing to increase HRQOL in patients with T2DM. The results of this SR will provide a deeper understanding on the relationship between patient empowerment and psychosocial outcomes in T2DM. Systematic review registration: PROSPERO CRD42020192429.

PsycINFO

Depression

10.21203/rs.3.rs-80089/v1

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Exploring value creation in a virtual community of practice: a framework analysis for knowledge and skills development among primary care professionals

BMC Medical Education (2024)

Débora Koatz Alezandra Torres‐Castaño Cristina Salrach-Arnau Lilisbeth Perestelo‐Pérez Vanesa Ramos‐García

Abstract Background Healthcare professionals traditional education reflects constraints to face the complex needs of people with chronic diseases in primary care settings. Since more innovative and practical solutions are required, Virtual Community of Practices (vCoP) seem to better respond to learning updates, improving professional and organizational knowledge. However, little is known about the value created in vCoPs as social learning environments. The objective of this project was to explore the value creation process of a gamified vCoP (“e-mpodera vCoP”) aimed at improving the knowledge and attitudes of primary healthcare professionals (PCPs) (nurses and general practitioners) to the empowerment of people with chronic conditions. Methods A framework analysis assessed the value creation process using a mixed methods approach. The framework provided awareness about knowledge and usefulness in a learning community through five cycles: (1) immediate value, (2) potential value, (3) applied value, (4) realized value, and (5) reframing value. Quantitative data included vCoP analytics such as logins, contributions, points, badges, and performance metrics. Qualitative data consisted of PCPs’ forum contributions from Madrid, Catalonia, and Canary Islands over 14 months. Results A total of 185 PCPs had access to the e-mpodera vCoPs. The vCoP showed the dynamic participation of 146 PCPs, along 63 content activities posted, including a total of 3,571 contributions (including text, images, links to webpages, and other files). Regarding the value creation process, the e-mpodera vCoP seems to encompass a broad spectrum of value cycles, with indicators mostly related to cycle 1 (immediate value – activities and interactions) and cycle 2 (potential value – knowledge capital); and to a lesser extent for cycle 3 (applied value – changes in practice) and for cycle 4 (realized value – performance improvement). The presence of indicators related to cycle 5 (reframing value), was minimal, due to few individual redefinitions of success. Conclusion To reach a wider range of value possibilities, a combination of learning objectives, competence framework, challenged-based gamified platform, and pathway model of skill development seems crucial. However, additional research is required to gain clearer insights into organizational values, professionals’ lifelong educational needs in healthcare, and the long-term sustainability of performance improvement. Trial registration ClinicalTrials.gov, NCT02757781. Registered on 02/05/2016.

Co-Creation

Value (mathematics)

10.1186/s12909-024-05061-6

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PP82 Prevention And Intervention Software Applications For People At Risk Of Suicide: Effectiveness And Safety

International Journal of Technology Assessment in Health Care (2024)

Amado Rivero‐Santana Andrea Duarte‐Díaz Yolanda Álvarez‐Pérez Renata Linertová Alezandra Torres‐Castaño

Introduction Suicide poses a severe public health challenge worldwide, impacting individuals, families, work, and society. The multifaceted nature of suicide demands a complex approach involving psychological, biological, social, cultural, and environmental factors. Recognizing suicide’s status as the leading external cause of death in Spain, prevention increasingly incorporates technology, specifically mobile and software applications. Methods A systematic review of the effectiveness and safety of mobile and software applications was conducted (MEDLINE, Embase, CINAHL, and PsycINFO databases). Outcome variables included: suicide; suicidal behavior; suicidal intent; suicidal ideation/thinking; self-perceived suicide risk; using/seeking mental health services; associated mental symptoms; mental health-related quality of life; satisfaction of the user and the health professional; adverse events related to the app, as defined in the included studies. Studies that do not include suicidal behavior, intention, or ideation were excluded. Where available data allowed, a meta-analysis was conducted for each outcome variable. Results One systematic review and 13 randomized controlled trials (n=2,952) were analyzed. No significant differences were found in deaths by suicide or suicide attempts. At post-intervention, small but significant reductions were observed in suicidal ideation, hopelessness, depression, and worry, with anxiety reduction slightly above statistical significance. At follow-up (8 to 52 weeks), these variables also obtained significant results, except depression and suicidal ideation. Regarding safety, there was no significant difference in safety phone calls for participants with suicidal ideation. Conclusions The evidence on suicide prevention app effectiveness is of low quality, precluding conclusive findings. Attempt reduction is suggested at 21 percent, but the confidence interval includes a potential 60 percent increase. Evidence on suicide-related psychological variables (suicide ideation, depression, hopelessness, and anxiety) is of higher quality (low–moderate), but effects are small and clinically uncertain. Safety findings are uncertain, impacting risk/benefit balance.

10.1017/s0266462324002514

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Patient-reported outcome measures for knowledge transfer and behaviour modification interventions in type 2 diabetes—the INDICA study: a multiarm cluster randomised controlled trial

BMJ Open (2021)

Yolanda Ramallo‐Fariña Amado Rivero‐Santana Lidia García‐Pérez Miguel Ángel García Bello Ana M. Wägner

This study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients' (T2DM) reported outcomes measures (PROMs) in the long-term.

Depression

Self-Management

10.1136/bmjopen-2021-050804

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Citations (14)

Factors associated with patient empowerment in Spanish adults with type 2 diabetes: A cross‐sectional analysis

Health Expectations (2022)

Andrea Duarte‐Díaz Himar González‐Pacheco Amado Rivero‐Santana Yolanda Ramallo‐Fariña Lilisbeth Perestelo‐Pérez

Abstract Objective The aim of the present study is to identify factors associated with patient empowerment in people living with type 2 diabetes mellitus (T2DM) in the Canary Islands (Spain). Methods Secondary cross‐sectional analysis was carried out of data obtained in the INDICA study: A 24‐month cluster randomized‐controlled trial evaluating the effectiveness of educational interventions supported by new technology decision tools for T2DM patients. Sociodemographic variables, clinical data (years since diagnosis, glycated haemoglobin level, creatine, triglycerides, waist hip index, body mass index and number of comorbidities), diabetes knowledge (DIATEK), affective outcomes (Beck Depression Inventory‐II, the State subscale of the State‐Trait Anxiety Inventory and The Diabetes Distress Scale) and diabetes‐related quality of life (The Audit of Diabetes‐Dependent Quality of life) were assessed as potential correlates of patient empowerment, assessed using the Diabetes Empowerment Scale‐Short Form. Multilevel mixed linear regression models on patient empowerment were developed. Results The analysis included the baseline data of 2334 patients. Results showed that age ( B = −0.14; p < .001), diabetes knowledge ( B = 0.61; p < .001) and state‐anxiety ( B = −0.09; p < .001) are significantly associated with patient empowerment. Sex, education level, living alone, employment status, country of birth, time since diagnosis, number of comorbidities, glycated haemoglobin level, depression and distress were not independently associated with patient empowerment in the multivariate analyses. Conclusion Younger age, lower state‐anxiety and greater diabetes‐specific knowledge are important correlates of patient empowerment. In line with the results of the INDICA study, interventions based on patient‐centred care might be effective in improving patient empowerment in adults with T2DM. Understanding the factors associated with empowerment may help clinicians and policymakers to identify high‐risk groups, prioritize resources and target evidence‐based interventions to better support people with T2DM to be actively involved in their own care. Patient or Public Contribution Patients with T2DM were actively involved in the design of the INDICA study. Two patient associations were included as part of the research team and actively participated in designing the interventions and selecting outcome measures.

Glycated hemoglobin

Beck Anxiety Inventory

10.1111/hex.13501

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209 Effectiveness of a web-based decision aid for patients with generalized anxiety disorder in Spain: a randomized controlled trial

Vanesa Ramos‐García Wenceslao Peñate Castro Amado Rivero‐Santana Yolanda Álvarez Pérez Alezandra Torres‐Castaño

10.1136/bmjebm-2024-sdc.208

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Healthcare Professionals’ Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice

International Journal of Integrated Care (2024)

Alezandra Torres‐Castaño Lilisbeth Perestelo‐Pérez Débora Koatz Vanesa Ramos‐García Ana Isabel González‐González

Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)’ perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients’ values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings. Resumen Antecedentes: La incorporación de la toma de decisiones compartida (TDC) es una parte central del empoderamiento del paciente, ya que facilita una mayor activación, ganar control sobre la atención que recibe y desarrollar habilidades para resolver sus problemas de salud. A pesar de estos beneficios, todavía existen dificultades para implementar la TDC entre los profesionales sanitarios debido a factores internos de los propios profesionales y externos, relacionados con el contexto y los sistemas sanitarios. Objetivo: Explorar en el foro de una comunidad virtual de práctica (CVdP) las percepciones de los profesionales de atención primaria (PAP) sobre el modelo de TDC en función de sus ideas preconcebidas y su experiencia en la práctica clínica. Métodos: Se realizó un análisis de marco desde un abordaje cualitativo de las intervenciones hechas por los PAP en el foro de una CVdP. Esta CVdP se implementó dentro de un ensayo clínico aleatorizado por grupos desarrollado en el proyecto e-MPODERA. Resultados: Los aspectos más importantes relacionados con la TDC desde la perspectiva de los PAP incluyeron: explorar los valores, preferencias y expectativas de los pacientes, proporcionarles información actualizada y basada en la evidencia, y comprobar su comprensión. En el análisis posterior, tres categorías emergieron como los temas más relevantes: determinantes de la implementación del TDC, falta de consistencia y dilemas, y beneficios de la escucha activa de los PAP, motivación y expectativas positivas de la TDC. Discusión: En nuestro análisis inicial, examinamos las conexiones entre las categorías del modelo de TDC y su aplicación en el contexto de atención primaria. Las categorías relacionadas con el modelo reflejan la comprensión teórica de los profesionales, mientras que las relativas a las percepciones de su aplicación y uso muestran ciertas discrepancias. Estas discrepancias podrían indicar una falta de comprensión del modelo y de sus implicaciones en el mundo real o un compromiso insuficiente por parte de los profesionales o de la organización para garantizar su aplicación efectiva. Conclusión: Una formación específica que aborde los conocimientos, las actitudes y la práctica puede resolver los hallazgos mencionados. Palabras Clave: Atención primaria; Profesionales sanitarios; Percepciones; Empoderamiento; Toma de decisiones compartida; Comunidad virtual de práctica

10.5334/ijic.6554

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Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial

Frontiers in Public Health (2024)

Tasmania del Pino‐Sedeño Himar González‐Pacheco Beatriz González de León Pedro Serrano-Pérez Francisco J. Acosta

Aim To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms ( B = −0.39; 95%CI: −0.65, −0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms ( B = −0.63; 95%CI: −0.96, −0.30; p < 0.001) and mental quality of life ( B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.

Collaborative Care

Depression

10.3389/fpubh.2024.1320159

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Treatment of Trochanteric Hip Fractures with Cephalomedullary Nails: Single Head Screw vs. Dual Integrated Compression Screw Systems

Journal of Clinical Medicine (2023)

M.M. Méndez-Ojeda Alejandro Herrera-Rodríguez Nuria Álvarez-Benito Himar González‐Pacheco Miguel Ángel García Bello

Extracapsular hip fractures are very common in the elderly. They are mainly treated surgically with an intramedullary nail. Nowadays, both endomedullary hip nails with single cephalic screw systems and interlocking double screw systems are available on the market. The latter are supposed to increase rotational stability and therefore decrease the risk of collapse and cut-out. A retrospective cohort study was carried out, in which 387 patients with extracapsular hip fracture undergoing internal fixation with an intramedullary nail were included to study the occurrence of complications and reoperations. Of the 387 patients, 69% received a single head screw nail and 31% received a dual integrated compression screw nail. The median follow-up was 1.1 years, and in that time, a total of 17 reoperations were performed (4.2%; 2.1% for single head screw nails vs. 8.7% for double head screws). According to the multivariate logistic regression model adjusted for age, sex and basicervical fracture, the adjusted hazard risk of reoperation required was 3.6 times greater when using double interlocking screw systems (p = 0.017). A propensity scores analysis confirmed this finding. In conclusion, despite the potential benefits of using two interlocking head screw systems and the increased risk of reoperation in our single center, we encourage to other researchers to explore this question in a wider multicenter study.

10.3390/jcm12103411

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