Anna García-Altés, Head of the Catalan Health System Observatory
This report presents the results of all SISCAT primary care teams (PCT) for 2014. This year, the structure of the report is slightly different from previous years. It deals with fewer topics but in a more concrete, in-depth manner. A special effort has been made to include indicators of nursing care evaluations, an area little discussed up until now in the Results Centre reports, and other new indicators from records that so far have not been analyzed in the reports. Some examples of these indicators are: the percentage of diabetic patients with related treatment diagnoses or the A&E MBDS indicators. However, the tables with the values of all indicators centre by centre -the distinguishing feature of the Results Centre- remain. As in previous years, all reports include innovative experiences that provide good care results, included in the Observatori d’Innovació en Gestió de la Sanitat in Catalonia as well as the experts’ opinion.
75.0% of the population assigned to a PCT was attended to by their team at least once; and 96.2%. in the case of the population aged 75 years or more. In 2014, the PCT attended 44,728,296 visits, representing an average of 7.6 visits per attended person.
As for the adequacy of the activities of the PCT, the rate of hospital emergencies, including hospitals and CUAP (Primary Care A&E) is declining but still remains high: it has gone from 471.0 to 428.0 per 1,000 people. Of these, 67.1% are level 4 and 5, i.e. less urgent situations and non-emergency situations. Potentially avoidable hospitalizations are stable with relatively high values, both overall and by COPD or Heart Failure. The variability in this indicator shows that there is room for improvement in results of some of the teams. As to pharmaceutical prescriptions, the percentage of patients taking multiple medications is at 0.05%, a relatively stable value in recent years, after all policies aimed at containing pharmaceutical expenditure and appropriateness of prescribing.
The effectiveness of primary care in type 2 diabetes mellitus is good. By 2014, the prevalence of diabetes treated in primary care was 9.1% in the reference population of 15 years and over. However, 10% of the PCT have reported prevalence of diabetes lower than 4.9%, which probably means registration problems that could be improved and that would allow having a more precise understanding of this disease. In terms of treatment, 71.6% of patients diagnosed with diabetes in primary care have been treated with non-insulin anti-diabetic drugs.
Regarding vaccination coverage of the child population, this maintains at high levels and shows little variability between PCT; the flu vaccination coverage however, has a tendency to gradually decrease and this year is below 50% of the population aged 60 years or older (48.5%). Moreover, the coverage of the ATDOM program (Home Care), appropriate for complex chronic patients, has increased slightly (from 9.5% in 2012 to 10.3% in 2014), although a great variability is observed among various PCTs. As for the two Essencial project recommendations for adding value to clinical practice (http://essencialsalut.gencat.cat) which oversees the Results Centre, the PPIs consumption continues at high and very similar values to 2013. On the other hand, the percentage of women with long-term bisphosphonate treatment has been reduced a little more, reaching 3.5% in 2014 and reflects all the efforts that have been carried out by professionals, medical societies, service providers and support programs for improving clinical practice.
As in previous years, the analysis of the results of this report can be deepened through the Results Centre’s applicative and the dynamic calculation sheets available on the Observatory’s website (http: //observatorisalut.gencat.cat), as well as through open data files that, while meeting W3C international standards, are available to all on the Generalitat de Catalunya website (http://dadesobertes.gencat.cat/ca). Finally, similarly to last year, a summary of the results in the form of an info-graphic has been published.
This report, and all the presented data, can be found on the Observatory website: http://observatorisalut.gencat.cat