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      Integration of health care in the Basque Country during COVID-19: the importance of an integrated care management approach in times of emergency

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          Abstract

          The main objective of this study is to analyse the process of integration of health care implemented in the public health system (Osakidetza) of the Autonomous Community of the Basque Country (CAPV), and assess whether the steps taken to date have helped or hindered the work of health personnel in times of COVID-19. Based on a case study, an assessment is made of the way in which certain tools of the integration process have been applied, if they have worked well and if they have led to better management of the pandemic.

          For the purpose of this study, a qualitative methodology is chosen consisting of a case study and in-depth interviews with health personnel at the front line of the integration process and the fight against COVID-19.

          This study makes two fundamental contributions. First, it analyses the health integration process in recent years in the public health system of the Basque Country. Second, it gathers the perceptions of different agents related to the Basque Health System of the way in which the tools of the integration process implemented in recent years have worked during the pandemic, detailing the positive and negative perceptions in this regard.

          Our conclusions offer a series of strategic recommendations linked to comprehensive patient care and the use of tools related to teleconsulting: the unified medical record, electronic prescription, and non-face-to-face care channels.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Methods for the thematic synthesis of qualitative research in systematic reviews

            James Thomas, Angela Harden (2008)
            Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.
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              Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

              Anthony Smith, Emma Thomas, Centaine Snoswell … (2020)
              The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Prim Health Care Res Dev
                Journal ID (iso-abbrev): Prim Health Care Res Dev
                Journal ID (publisher-id): PHC
                Title: Primary Health Care Research & Development
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 1463-4236
                ISSN (Electronic): 1477-1128
                Publication date (Electronic, collection): 2021
                Publication date (Electronic): 11 August 2021
                Volume: 22
                Electronic Location Identifier: e39
                Affiliations
                Department of Finance Economics II, University of the Basque Country (UPV/EHU) , Leioa, Biscay, Spain
                Author notes
                Author for correspondence: Izagirre-Olaizola Julen, Department of Finance Economics II, University of the Basque Country (UPV/EHU) , Oñati Plaza 1, 20018, Donostia, Gipuzkoa, Spain. E-mail: julen.izaguirre@ 123456ehu.eus
                Author information
                https://orcid.org/0000-0002-8854-3995
                https://orcid.org/0000-0003-0090-3739
                Article
                Publisher Item ID: S146342362100044X
                DOI: 10.1017/S146342362100044X
                PMC ID: 8365390
                PubMed ID: 34376273
                SO-VID: dce7ce1d-b767-468f-a593-df2a499ea857
                Copyright © © The Author(s) 2021
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 December 2020
                Date revision received : 01 April 2021
                Date accepted : 28 May 2021
                Page count
                Figures: 4, Tables: 2, References: 37, Pages: 11
                Categories
                Subject: Research Article

                Keywords: basque country,covid-19,health system,integrated care,public management
                Data availability:
                Keywords: basque country, covid-19, health system, integrated care, public management

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