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Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores : Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains : Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items . Global telemedicine specialists ( n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.

BackgroundThe rise of digital health services, especially following the outbreak of COVID-19, has led to a need for health literacy policies that respond to people’s needs. Spain is a country with a highly developed digital health infrastructure, but there are currently no tools available to measure digital health literacy fully. A well-thought-through questionnaire with strong psychometric properties such as the eHealth Literacy Questionnaire (eHLQ) is important to assess people’s eHealth literacy levels, especially in the context of a fast-growing field such as digital health. ObjectiveThis study aims to adapt the eHLQ and gather evidence of its psychometric quality in 2 of Spain’s official languages: Spanish and Catalan. MethodsA systematic cultural adaptation process was followed. Data from Spanish-speaking (n=400) and Catalan-speaking (n=400) people were collected. Confirmatory factor analysis was used to confirm the previously established factor structure. For reliability, the Cronbach α and categorical ω were obtained for every subscale. Evidence of convergent and discriminant validity was provided through the correlation with the total score of the eHealth Literacy Scale. Evidence based on relations to other variables was evaluated by examining extreme values for educational level, socioeconomic level, and use of technology variables. ResultsRegarding the confirmatory factor analysis, the 7-factor correlated model and the 7 one-factor models had adequate goodness-of-fit indexes for both Spanish and Catalan. Moreover, measurement invariance was established between the Spanish and Catalan versions. Reliability estimates were considered adequate as all the scales in both versions had values of >0.80. For convergent and discriminant validity evidence, the eHealth Literacy Scale showed moderate correlation with eHLQ scales in both versions (Spanish: range 0.57-0.76 and P

Abstract Background Unsafe sex is one of the main morbidity and mortality risk factors associated with sexually transmitted infections (STIs) in young people. Behavioral change interventions for promoting safe sex have lacked specificity and theoretical elements about behavior in their designs, which may have affected the outcomes for HIV/AIDS and STI prevention, as well as for safe sex promotion. This study offers an analysis of the barriers and facilitators that, according to the university students who participated in the focus groups, impede or promote the success of interventions promoting healthy sexuality from the perspective of the actions stakeholders should undertake. In turn, this study proposes intervention hypotheses based on the Behavior Change Wheel which appears as a useful strategy for the design of intervention campaigns. Methods Two focus groups were organized with students from Universidad de Santiago de Chile (USACH). The focus groups gathered information about the perceptions of students about sex education and health, risk behaviors in youth sexuality, and rating of HIV/AIDS and STI prevention campaigns. In the focus groups, participants were offered the possibility of presenting solutions for the main problems and limitations detected. After identifying the emerging categories related to each dimension, a COM-B analysis was performed, identifying both the barriers and facilitators of safe sex behaviors that may help orient future interventions. Results Two focus groups were organized, which comprised 20 participants with different sexual orientations. After transcription of the dialogues, a qualitative analysis was performed based on three axes: perception about sex education, risk behaviors, and evaluation of HIV/AIDS and STI prevention campaigns. These axes were classified into two groups: barriers or facilitators for safe and healthy sexuality. Finally, based on the Behavior Change Wheel and specifically on its ‘intervention functions’, the barriers and facilitators were integrated into a series of actions to be taken by those responsible for promotion campaigns at Universidad de Santiago. The most prevalent intervention functions are: education (to increase the understanding and self-regulation of the behavior); persuasion (to influence emotional aspects to promote changes) and training (to facilitate the acquisition of skills). These functions indicate that specific actions are necessary for these dimensions to increase the success of promotional campaigns for healthy and safe sexuality. Conclusions The content analysis of the focus groups was based on the intervention functions of the Behavior Change Wheel. Specifically, the identification by students of barriers and facilitators for the design of strategies for promoting healthy sexuality is a useful tool, which when complemented with other analyses, may contribute improving the design and implementation of healthy sexuality campaigns among university students.

BackgroundDepression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. ObjectiveIn this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. MethodsA systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. ResultsA total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=−0.62, 95% CI −0.87 to −0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. ConclusionsThis review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. Trial RegistrationPROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684

BackgroundSeveral systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted. ObjectiveThis overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions. MethodsThrough a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors. ResultsThis overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted. ConclusionsThe application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers. Trial RegistrationPROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375

Background: Sleep is an essential element for patients’ recovery during a period of hospitalisation. Hospital Clínic de Barcelona has developed the ClíNit project to promote patients’ sleep by identifying elements that affect the quality of sleep and implementing actions to improve rest at night. Objective: Our aim is to select actions to improve sleep quality. Methods: The study population included night-shift nurses from two clinical units where the pilot actions were to be carried out (n: 14). The nurses prioritised actions to improve sleep quality using the methodology proposed by Fogg: clarification, magic wand, crispification, and the focus-mapping technique. Results: Two sessions were organised for each unit and 32 actions considered high impact and easy to implement were proposed, of which 43.75% (14/32) were directly dependent on nurses. It was then agreed to implement four of these pilot studies. Conclusions: One aspect worth highlighting is that using prioritization techniques such as the Fogg technique is a good strategy to implement the general objectives of intervention programmes in large organizations in an easy way.

Abstract Background Monitoring results regarding the effectiveness of knee and hip arthroplasties may be useful at the clinical, economic and patient level and help reduce the number of prosthesis revisions. In Spain, and specifically in Catalonia, there is currently no systematic monitoring of the different prosthesis models available on the market. Within this context, the aim of the project presented in this protocol is to evaluate the short- and medium-term effectiveness of knee and hip models implanted in Catalonia and to identify where the results could be better or worse than expected. Methods A prospective observational design will be drawn up based on data from a population-based arthroplasty register for hip and knee replacements that includes data from 53 of the 61 public hospitals in Catalonia. The knee and hip prosthesis models used will be identified and classified according to the type of prosthesis, fixation and, in total hip replacements, the bearing surface. For the data analysis, two methodological approaches will be used sequentially: first, an approach based on a survival analysis, followed by an approach based on standardised revision ratios and funnel plots. Following the analyses, a panel of experts will evaluate the results to identify possible sources of bias. Lastly, those models with results better or worse than expected compared to those from the comparison group will be valued, and strengths and difficulties for routine implementation of this methodology within the Catalan Arthroplasty Register will be identified. Discussion The study presented in this protocol will allow us to identify the hip and knee prosthesis models whose results might be better or worse than expected. This information could have a potential impact at the patient, orthopaedic surgeon, healthcare manager, decision-making and industry levels, both in the short term and in the medium and long term.

Abstract Background Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. Methods This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. Discussion This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. Trial registration ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.

Mental Health management involve several actors and a high level of services integration. Our objective is to develop a strategy for specifically assessing the quality of Mental Healthcare performance in Catalonia using a methodology developed by AQuAS based on(1): a) to identity the indicators more adequate for the assessment; b) to identify the integrated care programmes for Mental Health (ICP-MH) actives in Catalonia; c) to pilot the implementation of a set of indicators using the Basic Healthcare Areas (BHA) as analysis unit. Methods: Indicators identification: using a structured literature review (Pubmed, grey literature, handmade search). Indicators were classified according the dimensional framework for integrated care assessment developed by AQuAS (2). ICP-MH identification: identified through a documental search (providers’ websites, technical reports, institutional databases such as the Observatori d’Innovació en Gestió Sanitària, etc). Main characteristics were collected (pe: presence of a case manager, integral assessment of the patient, individualized plans, etc) in order to determine the degree of integration. BHAs covered by programmes were also identified. Piloting indicators implementation: ratio of observed/expected cases was calculated for each BHA in each indicator for severe mental health disorders (IDC-10 codes). Data belonged to 2015-2016 and were obtained from the Catalan public health system databases (SISCAT). Performance results of BHA with ICP-MH were compared with those without ICP-MH through funnel plots and Poisson regression. Results: Indicators: 343 indicators were identified that mainly belonged to Effectiveness (22,5%) and Accessibility (21,8%) dimensions, followed by Continuity of Care (14,8%) and Efficiency (13,5%). The rest belonged to other dimensions. Programmes: 43 active ICP-MH were identified, mainly in the Health Region of Barcelona (58,1%), then Girona (14,0%), Camp Tarragona (9,3%) and Alt Pirineu & Aran, Lleida and Catalunya Central (2,3% each one). Any programme was found in Terres del Ebre Health Region. Implementation: according to the availability in public health databases were implementes "Readmissions before 30 days", "Urgent admissions", "Average length of stay", and "Length of stay longer than 30 days". Areas with ICP-MH had lower rates of readmissions, urgent admissions, and lengths of stay longer than 30 days. Discussions: Both the heterogeneity of the ICP-MH and the lack of indicators available fully addressed to integrated care complicate the assessment. Conclusions: BHA with ICP-MH had a better performance on hospital indicators when compared with areas without ICP-MH regarding severe mental disorders. Lessons learned: - indicators identified focused on Efectiveness rather than in Continuity or Integrated Care - there are several differences in the concept of "integrated care" - public Catalan databases are not ready for assessing ICP-MH Limitations: - lack of structured information about ICP-MH - the number of available indicators in mental health public databases is small and sometimes of low quality - available indicators in public databases don’t capture integrated care attention Suggestions for future research: The list of identified indicators will be validated with professionals, careers and patients for choosing those that better captures the quality of care. References: 1- Robles N, et al. Int J Integr Care. 2017;17(5):A389. 2- Espallargues M, et al. Rev Esp Salud Publica. 2016;90:1–16

Background: Integrated patient-centered care is a call for fundamental shift in how health care services are delivered as it is believed to improve patient outcomes and experience. Patient-Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are powerful tools as they provide validated information on patient's perception. REDISSEC, the Spanish Research Network on Health Services Research on Chronic Patients, is developing various projects on this field. Aims and Objectives: The workshop will cover three objectives: Provide an overview of the use of PROMs and PREMS in different situations and patient’s profile. Reflect on their advantages and disadvantages, problems or limitations. Discuss how to incorporate them into clinical practice in an integration health care environment. Format: Total duration: 1h. Each speaker will have 8 minutes for presenting, and 20 min for a final joint discussion, following this schedule: Contents / Time: Welcome to the workshop. Chair: Jose Maria Quintana. Hospital Galdakao-Usansolo. 0 min “Patient centered outcomes in multimorbidity: quality of life, comorbidity and other issues” Maria João Forjaz. ENS-ISCIII. This talk will focus in the problem of multimorbidity (MM), the importance of measuring PRO in MM, including quality of life and comorbidity scales. 8 min “The measure of functionality in elder adults: benefits and challenges”. Itziar Vergara. Unidad Investigacion APOSIS Gipuzkoa, Osakidetza. Being function a complex construct, a number of questions arise: what measures are the most appropriate? How has to be explored considering clinical settings? Are health professionals trained to do so? 16 min “Measuring health-related quality of life with the EQ-5D instruments: how-to for clinicians and decision makers” Juan Manuel Ramos-Goñi. Axentiva Solutions. The EQ-5D instrument is especially relevant in the care of chronic patients where integrated care is essential for effective and efficient patient management. 24 min “Priorization of PROMs in the assessment of the quality of health care provided to chronic patients”. Noemí Robles. Universitat Oberta de Catalunya. In this talk we will review how PROMs have been prioritised in the design of the assessment strategies through four research projects undertaken during the period 2013-2018. 32 min “Measuring satisfaction with Primary Care: the perspective of patients in 7 European Countries” Antonio Sarría-Santamera. ENS-ISCIII. The EUPRIMECARE project developed an instrument to measure satisfaction with Primary Care (PC), which was applied in 7 EU countries. Factors related to greater satisfaction with PC were: age, visits to a specialist, having a PC doctor and higher intensity of diagnostic & control performed in PC. 40 min Joint discussion: Participants: Speakers and audience Target audience: Researchers, clinicians and managers who are engaged in the design and delivery of integrated care. Learnings/Take away: What are the advantages and disadvantages when using PROMs and PREMs in clinical practice and in integrated care. What are the advances in specific fields as fragility or multimorbidity. How to use and interpret the results of these tools in real life.

Introduction: Management of Autism Spectrum Disorder (ASD) requires complex and integrated interventions, usually tailored for each individual due to the wide variety of symptoms that people diagnosed with ASD present. Some of these interventions could be a combination of psychosocial interventions addressed to the management of emotions, the improvement of social and communicative skills and/or the increase of the autonomy. In this scenario, professionals, families and patients face two main difficulties when they have to choose the best option/s for treatment: a) the lack of evidence on the effectiveness and efficacy of these interventions and the difficulty to access to it; and b) the lack of tools for supporting the decision making process neither for professionals nor for careers/patients. The objective of AUTAPP is to develop an evidence based personalised Clinical Decision Support System (CDSS) using a mobile technology tool (app) to improve the decision process specifically for psychosocial therapies for the management of ASD. Methods: AUTAPP is based on two stages: 1- Review and synthesis of the scientific evidence for the effectiveness and efficacy of psychosocial interventions in the management of ASD. Main databases (PubMed, Cochrane Library, PsychoInfo, EMBASE) will be consulted and the quality of the chosen publications will be assessed following SING criteria. Two independent reviewers will review articles and relevant information will be synthesized in evidence tables. The algorithm of decision-making will be developed based on these tables. 2- Design, development and validation of the CDSS. The decision-making algorithm will be implemented in a mobile platform. Professionals, careers and people diagnosed with ASD will validate the app to obtain the final version ensuring its face-validity and feasibility. Results: The first phase is currently in progress (we started in January 2018) and will be finalised in December. Thus in April 2019 the results of the systematic review and the first prototype of the CDSS will be available. We expect this review to enrich information respect previous that reported scarce evidence on psychosocial interventions (1). Discussions: Quality of the published research on psychosocial interventions in ASD will determine the reach of the mobile CDSS. Conclusions: Mobile technology could both facilitate the decision making process when therapeutical approach is complex and requires integration such as in ASD; and enhance the empowerment of ASD people. Lessons learned: Based on similar projects developed by the team: - professionals could base their clinical recommendations on real evidence and propose the most personalised interventions - this kind of tools facilitate patient/careers empowerment Limitations: - lack of scientific evidence published, publications of low quality and publication bias - lack of motivation for professionals to use the CDSS or usefulness of the CDSS in the clinical practice Suggestions for future research: - systematic review will allow to identify gaps in psychosocial interventions research - this approach could be implemented in other chronic diseases Reference: 1- Guillamón I, Rajmil L, Espallargues M. Trastorn de l’espectre autista: coneixement científic sobre la detecció, el diagnòstic i el tractament. Barcelona: AQuAS. Servei Català de la Salut. Departament Salut. Generalitat Catalunya; 2010.

El objetivo del trabajo fue desarrollar un marco conceptual para la evaluación de nuevos programas de gestión clínica y asistencial de carácter integrado en el Sistema Nacional de Salud para la atención a las personas con enfermedades crónicas. Se realizó una revisión exhaustiva de la literatura entre 2002-2013 incluyendo revisiones sistemáticas, metaanálisis e informes con modelos de evaluación y/o evaluaciones de programas. Se estudiaron y describieron programas locales de atención a la cronicidad implementados en Cataluña y se realizaron entrevistas semiestructuradas con expertos clave en el ámbito catalán. El alcance y el marco conceptual se definieron mediante la técnica del brainstorming. De 910 resúmenes identificados, se incluyeron 116 documentos que se referían a marcos conceptuales e indicadores de evaluación a nivel español e internacional. Se identificaron 24 programas de atención a la cronicidad (9 de carácter integrado). El marco conceptual propuesto contempló: 1) la población diana según niveles de complejidad; 2) un enfoque de evaluación de la estructura, procesos y resultados teniendo en cuenta el estado de salud conseguido, el proceso de recuperación y mantenimiento de la salud; y 3) las dimensiones o atributos que se deben evaluar. El marco conceptual propuesto permitirá desarrollar indicadores e implementarlos con un enfoque comunitario, orientados a los resultados y tener una visión territorial o poblacional, que será imprescindible para saber cuál es la estrategia más efectiva, cuáles son los elementos que determinan un mayor éxito y cuáles son los grupos de pacientes que más se pueden beneficiar.

BackgroundThe objectives of the study were to develop web-based Spanish and Catalan versions of the KIDSCREEN, and to compare scores and psychometric properties with the paper version.MethodsInternet and paper Spanish and Catalan versions of the KIDSCREEN-52 were included in a cross-sectional study in school-age children. Web-based and paper Spanish or Catalan versions of the KIDSCREEN-52 were administered to students aged 8 to 18 years from primary and secondary schools in Palafolls (Barcelona, Spain, n = 923). All students completed both web-based and paper versions during school time with an interval of at least 2 hours between administrations. The order of administration was randomized. The KIDSCREEN-52, the Strengths and Difficulties Questionnaire (SDQ), and sociodemographic variables were collected. Missing values, floor and ceiling effects, and internal consistency were compared between both versions, as well as mean score differences, level of agreement, and known groups and construct validity.ResultsParticipation rate was 77% (n = 715). Web-based and paper versions showed low percentage of missing values and similar high ceiling effect (range 0 to 44%). Mean score differences showed an effect size (ES) lower than 0.2 in all dimensions. Internal consistency ranged from 0.7 to 0.88, and degree of agreement was excellent (Intraclass correlation coefficient [ICC] range 0.75 to 0.87). Expected differences were seen by sex, age, socioeconomic status and mental health status.ConclusionsThe web-based KIDSCREEN-52 showed similar scale score and reliability and validity than the paper version. It will incorporate the child population in the assessment of quality of life providing a more attractive format.