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Background: The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, a great opportunity has also opened up that can drive the reform of health systems to become high-performing, effective, equitable, accessible and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges. Methods: A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify subject matters (areas of intervention) behind the changes implemented to react to the COVID 19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. Results: The analysis of the interviews resulted in the identification of 106 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into 24 sub-themes, and these in turn into 7 themes. Specifically, the themes and sub-themes (in brackets) are: responsiveness (planning, governance, organisational elasticity and staff flexibility), telehealth (telecare, telework and telecoordination), integration (teamwork, collaborative networks, coordination with Public Health and partnerships), knowledge management (intellectual capital, scientific evidence, transmission and training), professional roles (reinforcement and innovation), digitisation (strategy, data analytics, automation and interoperability) and organisational communication (management, content and channels). The detailed description of each theme and subtheme is presented. Conclusions: The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and providing high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

Across the globe, the healthcare sector is experiencing transformations (cultural, social, digital and economic). This is due to the age and varying patient needs that are driving a shift in the healthcare landscape. At the same time, chronic diseases, social determinants and resource limitations continue to add pressure. Healthcare has thus shifted from paternalistic mode of care to patient centered care (PCC). The growing multiple divergent medical cases denote a need to collaboratively understand clinical issues and effectively determine the best course of action. With PCC, a patient is recognized as a unique human being before forming a diagnosis. This implies that there is a need for multifaceted decision-making. In this study, we use a co-construction participatory modeling approach to understand the complexities in collaboratively managing knowledge for multi-morbid chronic patients on Advance Care Plan (ACP). To achieve this, focus group discussions (FGD) with 12 participants (five healthcare professionals, three health managers and three healthcare key decision makers) from Basque Public Health System (Osakidetza), in Spain were involved in identifying the key challenges and developing a systemic thinking model. As a result, three key challenges were identified i.e. 1) culture (citizens are not willing to talk about death, 2) healthcare professionals’ challenge to change attitude and perspectives, and 3) changing the current system towards holistic and a shared care model. From the developed Causal loop diagrams (CLDs), it is noted that perpetuation of fragmented and paternalistic care is likely to get worse without recognition of the ACP as a social need and a crucial part of the clinical practice part change.

Introduction: Population longevity, morbidity and high consumption of medicines, have become polypharmacy a priority health problem due to its high prevalence and problems that can cause: lack of adherence, increased adverse effects and drug interactions, or functional deterioration. Treatment review in polymedicated patients is an essential activity to improve the appropriateness of treatments and avoid potential prescription-related safety problems.In the EU-funded GATEKEEPER project, the Basque Country region is running the use case “management of people with chronic diseases and polypharmacy”. It has implemented an intervention through a mobile application and web solution for the management of polypharmacy in multimorbid patients. Aims, Objectives, Theory And Methods: This quasi-experimental study (non-randomised, concurrent and controlled study) aimed to assess the effectiveness and user experience of two applications to optimize the detection of inappropriate therapeutic prescriptions (CheckTheMeds) and to improve adherence to treatment in patients (My Treatment) with chronic diseases and polypharmacy.The intervention is being carried out in 11 Integrated Healthcare Organizations from Osakidetza Basque Health Service. The target is to recruit 1,000 elderly people (500-intervention group and 500 control group) that fits with the inclusion criteria (aged more than 70 years or older, with more than 2 chronic diseases, and more than 9 drugs prescribed). Highlights Or Results Or Key Findings: Trained Primary Care healthcare professionals will contact 500 candidates for the intervention group, who will be invited to participate in the study and informed about it. After signing the informed consent form, their health status, prescribed drugs, and the adherence to the treatment will be revised and monitored for 9 months. Piloting will last since December 2021 to September 2022. A mixed methods approach will be employed, integrating quantitative and qualitative technics. Data obtained through different approaches (Questionnaires, administrative data, usage metrics, interviews information), will provide a broad understanding of what each approach has achieved and how or why results have been produced. Se invitará al paciente a utilizar la App corporativa ""Mi Tratamiento"" que fomentará la adherencia al tratamiento y hará que los pacientes y/o cuidadores sean conscientes de la medicación que tienen prescrita, se hagan cargo de su tratamiento y tengan comunicación con los profesionales sanitarios.Conclusions: This study pretends to give evidence how a treatment appropriateness, together with greater therapeutic adherence, will result in more effective treatments with fewer drug-related problems and health complications, and thus in improved efficiency in the use of healthcare resources and also increase quality of life of these patients.Implications For Applicability/Transferability/Sustainability: The use of CheckThemeds and App “Mi Tratamiento” tools will improve the adherence and prescription through the review of medicines that detect potentially inappropriate prescriptions and increase the rate of therapeutic compliance.Osakidetza Basque Health Service will integrate these platforms in the clinical practice as part of the multimorbid patient’s pathway.

Background/Objective Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is especially common in elderly patients. They tend to have more complicated chronic conditions that require the intake of multiple drugs. Inappropriate polypharmacy is usually associated with adverse drug events, interactions, non-adherence to prescribed medication, and increased risk of geriatric syndroms (falls, incontinence, malnutrition, cognitive impairment, delirium). The growth of applications to manage polypharmacy has significantly increased in recent years. However, the effectiveness of these applications for this purpose has not been evaluated. The EU-funded GATEKEEPER project, pretends to demonstrate the real-life effects of a digital ecosystem innovative platform for personalized treatments and therapies based on early detection and risk avoidance in a large-scale pilot study across eight European health references. The Basque country as deployment site will assess the effectiveness and the user experience of two digital solutions that could facilitate the management of polypharmacy in the elderly patients with multi-chronic diseases and polypharmacy.MethodologyThe intervention designed is focused on (i) providing primary care healthcare professionals with a computer-based tool (CheckTheMeds® web service) to facilitate the revision of medication and the identification of potentially inappropriate prescriptions in elderly patients with multi-chronic diseases, and (ii) providing elderly patients with a mobile health application (My treatment app) that will enable them to comply with and correctly follow with the prescribed pharmacological treatment.From February to June 2021 the adaptation and customization of the applications and the training of professionals will be carried out. In June 2021 the recruitment of 1000 patients (500 control group and 500 intervention group) will begin at two Integrated Healthcare Organizations in the Basque Country. This piloting of the intervention will begin in the October 2021 and will last by the September 2022. Patients in the intervention group will be monitored during 12 months and their health status and medication will be revised at the baseline, every 3-4 months during the follow-up, and at the end of the intervention. Qualitative and quantitative evaluation will be performed. Quantitative data will be collected through questionnaires, information of the administrative database of Osakidetza (Basque Country Healthcare provider) and the application servers at the beginning and end of the intervention. Qualitative data will be obtained by semi-structured interviews and focus groups at the end.ResultsThis study will assess the effectiveness and the user experience of two digital solutions that aim to improve polypharmacy management and adherence to prescribed medication, in order to reduce adverse effects of medication and increase patient´s quality of life.

Introduction The aging population, with the growing burden of chronic conditions and multimorbidity, is constantly increasing the demand for more comprehensive, efficient and smarter personalized care delivery based on innovative solutions. Digital innovation has the potential to improve coordination and provide more targeted, personalized, effective and efficient health care. The transformation of health systems in Europe and the design, development and implementation of innovative solutions ensuring systems’ sustainability is highly needed.Short description of practice change implemented In this framework, JADECARE (Joint Action on implementation of Digitally Enabled integrated person-centered CARE) intends to reinforce the capacity of health authorities to successfully address the transition to digitally-enabled integrated-person-centred care. It is focusing on the transfer and adoption of four original Good Practices (oGPs), concerning integrated care, chronic conditions, multimorbidity, frailty and complex needs, self-care, prevention and population health, disease and case management. They are: Basque Health strategy in ageing and chronicity: integrated care (Spain), Catalan open innovation hub on ICT-supported integrated care services for chronic patients (Spain), The OptiMedis Model-Population-based integrated care (Germany) and Digital roadmap towards an integrated health care sector (Denmark).Aim and theory of change During the JA, health authorities will improve knowledge in implementation and process evaluation methodologies including sustainability. The transfer of oGPs will focus on the preparation of the local environments for the implementation. The methodology will allow the transfer in different contexts: socioeconomic, cultural, legal, models and maturity of health systems. A learning community will be created for developing, collecting and exchanging knowledge through “twinning actions”, dedicated seminars and workshops, and other activities.Targeted population and stakeholdersJADECARE involves partners from 17 European countries, providing a complete scenario of the idiosyncrasy and differences that can be found. The local context, maturity of integrated care models, legal frameworks, culture/values and relevant leaders will be considered for each of the 23 “next adopters”. Timeline The project started on October 1st, 2020 and ends on September 30th, 2023.Highlights JADECARE will impact on European health systems by implementing innovative digital integrated care solutions and helping to change the model of care provision. It will settle the basis to implement integrated care at large scale by knowing how to transfer successful experiences and to create innovative/tailored practices. This will also have an impact on healthcare professionals, patients, carers, general population, health authorities and the industrial sector. Sustainability Elements of sustainability will be addressed in the implementation. The long-term effect of JADECARE will be supported by involving stakeholders participating in governance bodies who can provide political support and commitment to integrated care.Transferability A three-step implementation strategy will be used for oGP transfer. It was defined in JAChrodis-Plus to be appropriate from the scientific point of view, applicable considering data availability and feasible according to project´s timeline and resources: • Pre-implementation: planning and preparation• Implementation: roll-out and operation (based on PDSA cycles) • Post-implementation: impact assessment and learning Conclusions, Discussions, and Lessons learnedAs JADECARE has just started, we do not yet have conclusions, discussion nor lessons learned.

Data de publicació electrònica: 09-08-2022 Background: Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. Materials and methods: We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. Results: Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). Conclusions: Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions. Introducción: El objetivo fue medir las desigualdades en salud mental por estatus socioeconómico (ESE) y género en adolescentes y adultos jóvenes mediante un registro poblacional. Métodos: Se analizó a la población vasca de 1 a 30 años (n=609.381) el 31 de diciembre de 2018. Se buscaron los diagnósticos en los registros de atención primaria, ambulatoria especializada y hospitalaria. Estimamos la prevalencia de por vida desagregada según uso de sustancias, trastorno de conducta, ansiedad, depresión, psicosis y trastorno por déficit de atención con hiperactividad. El Instituto de Estadística validó los datos de mortalidad. La probabilidad ajustada de riesgos (AOR) se estimó mediante regresión logística. Resultados: En total, 96.671 personas (15,9%) tenían un trastorno mental diagnosticado con claros gradientes por género y ESE. Las mujeres de ESE medio a alto tuvieron la prevalencia más baja de todos los trastornos mentales, excepto en ansiedad y depresión. A este grupo le siguieron los hombres del mismo ESE y las mujeres con ESE bajo, mientras que la mayor prevalencia de trastornos mentales se observó en los hombres con ESE bajo. Las categorías de ingresos más bajos tuvieron mayores riesgos de ingreso psiquiátrico (AOR en mujeres 3,64; en hombres 6,66) y muerte (AOR: 5,42). Las personas con diagnóstico de salud mental tuvieron mayor mortalidad (AOR: 2,38). Conclusiones: Nuestro trabajo evidenció importantes desigualdades por ESE y género en salud mental y mortalidad prematura de adolescentes y adultos jóvenes, impulsando el desarrollo e implementación de intervenciones preventivas tempranas.

Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.