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In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged ≥15 years prescribed SO for ≥3 months continuously in 2013-2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <€18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs.

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The prescription of strong opioids (SO) for chronic non-cancer pain (CNCP) is steadily increasing. This entails a high risk of adverse effects, a risk that increases with the concomitant prescription of SO with central nervous system depressant drugs and with the use of SO for non-recommended indications. In order to examine this concomitant risk prescription, we designed a descriptive, longitudinal, retrospective population-based study. Patients aged ≥15 years with a continued SO prescription for ≥3 months during 2013-2017 for CNCP were included. Of these, patients who had received concomitant prescriptions of SO and risk drugs (gabapentinoids, benzodiazepines and antidepressants) and those who had received immediate-release fentanyl (IRF) were selected. The study included 22,691 patients; 20,354 (89.7%) patients received concomitant risk prescriptions. Men and subjects with a higher socioeconomic status received fewer concomitant risk prescriptions. Benzodiazepines or Z-drugs were prescribed concomitantly with SO in 15,883 (70%) patients, antidepressants in 14,932 (65%) and gabapentinoids in 11,267 (49%), while 483 (21.32%) patients received IRF (2266 prescriptions in total) without a baseline SO. In conclusion, our study shows that a high percentage of patients prescribed SO for CNCP received concomitant prescriptions with known risks, as well as IRF for unauthorized indications.

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The COVID-19 pandemic has forced the adoption of drastic changes in primary care, modifying the organization and work dynamics previously established. From one day to the next, professionals had to adapt to the new situation to be able to attend cases and contacts tracing, to avoid contagion and to maintain attention to other health problems. At the beginning of the pandemic, professionals had to establish new practices and care circuits in primary care in an improvised way, due to lack of updated guidelines, without adequate means of protection, evaluating their risks and benefits on the fly. We present the main organizational changes in the first level of care and describe, from the point of view of patient safety and the consequences for patients and professionals of the priority care for COVID-19. Finally, we consider how to incorporate the knowledge acquired during the pandemic, analyzing the advantages and disadvantages of the adopted measures to maintain as much as possible a safe, accessible and quality primary care.

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ObjetivoElaborar y validar un instrumento para medir aptitudes en soporte vital básico (SVB) y desfibrilación semiautomática (DSA) adaptado a los profesionales sanitarios de equipos de atención primaria. Proponer una versión actualizada y demostrar autosuficiencia del equipo para utilizarlo en evaluación formativa.DiseñoValidación de instrumentos de medida. Estudio de fiabilidad con medidas repetidas tras intervención formativa.EmplazamientoCentro de atención primaria Drassanes. Área Básica de Salud Raval Sud.ParticipantesTreinta y siete rescatadores voluntarios (total entre médicos y enfermeras), cámara profesional, médico controlador, maniquí informatizado, 6 evaluadores.IntervencionesMetodología de elaboración de test. Modelo Cardiff versión 3.1 (que se encuentra en internet). Ejecución: 2 series filmadas (una profesional y otra doméstica), de 26 a 25 simulaciones “tipo estación”, separadas por un mes. Taller formativo entre series. Evaluación retrospectiva de grabaciones DVD (6 evaluadores). Segunda serie nuevamente puntuada a las 3 semanas con ciego de versión filmada y orden aleatorizado.Mediciones principalesVariables: actuaciones categorizadas de peor a mejor ejecución. Análisis psicométrico: validez (contenido/aparente). Fiabilidad test-retest, intraobservador y sensibilidad al cambio.ResultadosRespecto al test de Cardiff (46 ítems), este test de 83 ítems contiene 38 (46%) nuevos, 34 (41%) modificados y 11 (13%) similares. La fiabilidad entre evaluadores fue excelente/buena en 51 de 62 ítems analizados; fiabilidad intraevaluador y entre filmaciones excelente/buena en todos los ítems, menos en uno; la prueba dobló la puntuación tras intervención formativa. Se propone una versión del test según las recomendaciones actuales en SVB y DSA(AU)

ConclusionesAl no disponer de instrumentos útiles para los médicos y enfermeras de atención primaria se ha elaborado uno con suficientes garantías psicométricas y se ha probado autosuficiencia evaluativa. Se propone aplicabilidad inmediata de la versión actualizada con fines de evaluación formativa(AU)

ObjectiveTo prepare and validate a tool to measure Basic Life Support (BLS) and semi-automatic defibrillator (SAD) skills adapted for use by health professionals in Primary Care Teams (PCT). To propose an updated version and demonstrate self-sufficiency of the team to use it in a training evaluation.DesignValidation of measurement tools. Study of reliability with repeated measurements after a training course.SettingDrassanes Primary Care Centre. Raval Sud Basic Health Area. Barcelona. Spain.ParticipantsA total of 37 voluntary resuscitators (all doctors/nurses), professional camera, medical controller, computerised mannequin, 6 evaluators.InterventionsTest preparation methodology. Cardiff Model 3.1. Implementation: 2 filmed series (professional+domestic), of 26-25 “station type” simulations, separated by 1 month. A training workshop between series. Retrospective evaluation of DVD recordings (5 evaluators). 2nd series scored again at 3 weeks with a blind and random order filmed version.Main measurementsVariables: performances classified from worse to best execution. Psychometric analysis: Validity (content/apparent). Test-retest reliability, between-observer and sensitivity to change.ResultsCompared to the Cardiff test (46 items) our 83 item test contained 38(46%) new, 34(41%) modified and 11(13%) similar. Between-evaluator reliability, excellent/good in 51/62 items analysed; Within-evaluator and between-filming reliability, excellent/good in all except 1 item; the test score doubled after the training course. A version of the test according to BLS-SAD recommendations is proposed.ConclusionsOn there not being useful tools available for Primary Care doctors and nurses, one has been prepared with adequate psychometric guarantees and proven self-sufficient evaluation. We propose the immediate application of the updated version for training evaluation purposes(AU)

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OBJECTIVE: To prepare and validate a tool to measure Basic Life Support (BLS) and semi-automatic defibrillator (SAD) skills adapted for use by health professionals in Primary Care Teams (PCT). To propose an updated version and demonstrate self-sufficiency of the team to use it in a training evaluation. DESIGN: Validation of measurement tools. Study of reliability with repeated measurements after a training course. SETTING: Drassanes Primary Care Centre. Raval Sud Basic Health Area. Barcelona. Spain. PARTICIPANTS: A total of 37 voluntary resuscitators (all doctors/nurses), professional camera, medical controller, computerised mannequin, 6 evaluators. INTERVENTIONS: Test preparation methodology. Cardiff Model 3.1. IMPLEMENTATION: 2 filmed series (professional+domestic), of 26-25 "station type" simulations, separated by 1 month. A training workshop between series. Retrospective evaluation of DVD recordings (5 evaluators). 2nd series scored again at 3 weeks with a blind and random order filmed version. VARIABLES: performances classified from worse to best execution. Psychometric analysis: Validity (content/apparent). Test-retest reliability, between-observer and sensitivity to change. RESULTS: Compared to the Cardiff test (46 items) our 83 item test contained 38(46%) new, 34(41%) modified and 11(13%) similar. Between-evaluator reliability, excellent/good in 51/62 items analysed; Within-evaluator and between-filming reliability, excellent/good in all except 1 item; the test score doubled after the training course. A version of the test according to BLS-SAD recommendations is proposed. CONCLUSIONS: On there not being useful tools available for Primary Care doctors and nurses, one has been prepared with adequate psychometric guarantees and proven self-sufficient evaluation. We propose the immediate application of the updated version for training evaluation purposes.

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