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Papers by patricia moreno

Acta Psychiatrica Scandinavica

Gaceta Sanitaria, 2020

Palabras clave: Atención primaria Trastornos de ansiedad Trastornos depresivos Trastornos de soma... more Palabras clave: Atención primaria Trastornos de ansiedad Trastornos depresivos Trastornos de somatización Resultados del tratamiento Reglas de predicción clínica Prevención primaria r e s u m e n En atención primaria solo el dolor crónico supera a la depresión y la ansiedad en la pérdida de años de vida ajustados por calidad. Más del 70% de las personas que sufrían enfermedades mentales comunes consultaron por ello a su médico/a de familia. Sin embargo, «la regla de las mitades decrecientes» es una realidad: menos del 50% de las personas consultantes de atención primaria con enfermedades mentales comunes fueron diagnosticadas correctamente, y de ellas, menos del 50% recibieron un tratamiento (farmacológico o psicológico) adecuado, y de estas, menos del 50% fueron adherentes. Los modelos colaborativos de atención a las enfermedades mentales comunes en atención primaria han demostrado su efectividad en ensayos clínicos, pero su implementación en un contexto más general y real es difícil y su efectividad todavía es poco conocida. Se han desarrollado y validado algoritmos de riesgo para predecir el inicio y el pronóstico de las enfermedades mentales comunes en atención primaria que son útiles para su tratamiento y prevención. Existen evidencias de que las intervenciones psicológicas, psicoeducativas y de ejercicio físico son efectivas en prevención primaria, incluso en atención primaria, aunque su efecto es pequeño o moderado. Estas intervenciones tienen un gran potencial para ser escalables en las escuelas, el ámbito laboral y la atención primaria; además, cuando se administran mediante tecnologías de la información y la comunicación (p. ej., App), en programas autoguiados o mínimamente guiados, han demostrado su efectividad para el tratamiento y la prevención de las enfermedades mentales comunes. También son muy accesibles y de bajo coste, y contribuyen a la implementación masiva de estas intervenciones en diferentes contextos.

PLOS ONE, 2014

<p>Young: 18–34 years; Middle-aged: 35–60 years; Mature: 61–75 years.</p

BMC Public Health, 2021

Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Chang... more Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering...

Frontiers in Psychology, 2021

Introduction Anxiety and depressive disorders are a significant problem that starts in childhood ... more Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with d...

British Journal of General Practice, 2020

BackgroundIn the predictD-intervention, GPs used a personalised biopsychosocial programme to prev... more BackgroundIn the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant.AimTo determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety.Design and settingSecondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012.MethodIn each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months.ResultsA total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligib...

Frontiers in Psychology, 2021

Various health settings have advocated for involving patients and members of the public (PPI) in ... more Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from thi...

Clinical Psychology Review, 2020

General rights Copyright and moral rights for the publications made accessible in the public port... more General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

BMJ Open, 2021

IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than... more IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents.MethodA systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer...

Revista de Neurología, 2020

PLOS ONE, 2019

Background The predictD intervention, a multicomponent intervention delivered by family physician... more Background The predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions.

BACKGROUND There is a high prevalence of children and young people (CYP) experiencing mental heal... more BACKGROUND There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. OBJECTIVE This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. METHODS A literature search was performed in the Cochrane Library, Excerpt...

PLOS ONE, 2018

Since the use of language is a core aspect of psychotherapy, its study requires instruments that ... more Since the use of language is a core aspect of psychotherapy, its study requires instruments that allow for further research. The aim of this study is to present an observational instrument capable of analyzing the language used in psychotherapeutic settings, both by therapists and clients. The SICOLENTE instrument was applied to two different samples: The Three Approaches to Psychotherapy film and a naturalistic sample. 7710 utterances from 31 sessions (three from the demonstration film and 28 from a naturalistic setting) were coded. Two studies were conducted: in the first study, inter and intra coder reliability (dimension and category levels) and Generalizability theory analyzes were assessed, whilst in the second study, construct validity was tested with several hypotheses. The final instrument resulted in 20 categories with three dimensions: Conversational Act (7 categories), Therapeutic topic (6 categories) and Content (7 categories). The three dimensions showed excellent inter and intra coder reliability and the generalizability coefficients were excellent. Out of the 24 validity hypothesis proposed,19 were accepted. The finding suggests that the SICO-LENTE is a reliable and valid instrument that can be applied to investigate the performance of various theoretical models. Its three dimensional structure gives it the flexibility to be able to carry out macroscopic or microscopic language research.

BMJ Open, 2018

IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing... more IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collabo...

PLOS ONE, 2018

Background Empirical evidence has shown that cardiac rehabilitation programs are effective in red... more Background Empirical evidence has shown that cardiac rehabilitation programs are effective in reducing morbidity and mortality, improving quality of life in patients with cardiovascular disease. Despite the benefits, women have a high cardiac rehabilitation dropout rate. Our aim was to explore women's perceptions about the reasons they faced for dropout from these programs. Methods Semi-structured interviews were conducted with women (n = 10) after dropping out from three different cardiac rehabilitation centers in Spain. In addition, a focus group and a semistructured interview with cardiovascular professionals were conducted. From a grounded theory perspective, thematic analysis was used to derive themes from interview transcripts. Results The women were between 41 and 70 years. We identified five general themes that illustrated reasons for cardiac rehabilitation dropout: intrapersonal reasons (self-reported health, self-reported mental health, health beliefs); interpersonal reasons (family caregiver role, work conflicts); logistical reasons (transport, distance); cardiac rehabilitation program characteristics (perception of the objective of cardiac rehabilitation, exercise component, inconvenient timing, cardiac rehabilitation equipment); and health system reasons (financial assistance for transport, long waiting list). The cardiovascular professionals found barriers to cardiac rehabilitation completion similar to those found by the women. Conclusions In order to prevent cardiac rehabilitation dropout in women, modular and flexible programs are needed. In addition, the inclusion of primary care centers or community resources could

BMC public health, Jan 13, 2018

Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ide... more Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficien...

BMC public health, Jan 13, 2018

It has been highlighted the original article (1) contained a typesetting mistake in the authorshi... more It has been highlighted the original article (1) contained a typesetting mistake in the authorship, and that author Caterine Vicens was omitted.

BMJ quality & safety, Jan 15, 2018

Copayment policies aim to reduce the burden of medication expenditure but may affect adherence an... more Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. A population-based study was conducted using real-world evidence. Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. Before changes to copayment policies, IMNA prev...

BMC medicine, Feb 23, 2018

Depression is viewed as a major and increasing public health issue, as it causes high distress in... more Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention i...

Acta Psychiatrica Scandinavica

Gaceta Sanitaria, 2020

Palabras clave: Atención primaria Trastornos de ansiedad Trastornos depresivos Trastornos de soma... more Palabras clave: Atención primaria Trastornos de ansiedad Trastornos depresivos Trastornos de somatización Resultados del tratamiento Reglas de predicción clínica Prevención primaria r e s u m e n En atención primaria solo el dolor crónico supera a la depresión y la ansiedad en la pérdida de años de vida ajustados por calidad. Más del 70% de las personas que sufrían enfermedades mentales comunes consultaron por ello a su médico/a de familia. Sin embargo, «la regla de las mitades decrecientes» es una realidad: menos del 50% de las personas consultantes de atención primaria con enfermedades mentales comunes fueron diagnosticadas correctamente, y de ellas, menos del 50% recibieron un tratamiento (farmacológico o psicológico) adecuado, y de estas, menos del 50% fueron adherentes. Los modelos colaborativos de atención a las enfermedades mentales comunes en atención primaria han demostrado su efectividad en ensayos clínicos, pero su implementación en un contexto más general y real es difícil y su efectividad todavía es poco conocida. Se han desarrollado y validado algoritmos de riesgo para predecir el inicio y el pronóstico de las enfermedades mentales comunes en atención primaria que son útiles para su tratamiento y prevención. Existen evidencias de que las intervenciones psicológicas, psicoeducativas y de ejercicio físico son efectivas en prevención primaria, incluso en atención primaria, aunque su efecto es pequeño o moderado. Estas intervenciones tienen un gran potencial para ser escalables en las escuelas, el ámbito laboral y la atención primaria; además, cuando se administran mediante tecnologías de la información y la comunicación (p. ej., App), en programas autoguiados o mínimamente guiados, han demostrado su efectividad para el tratamiento y la prevención de las enfermedades mentales comunes. También son muy accesibles y de bajo coste, y contribuyen a la implementación masiva de estas intervenciones en diferentes contextos.

PLOS ONE, 2014

<p>Young: 18–34 years; Middle-aged: 35–60 years; Mature: 61–75 years.</p

BMC Public Health, 2021

Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Chang... more Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering...

Frontiers in Psychology, 2021

Introduction Anxiety and depressive disorders are a significant problem that starts in childhood ... more Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with d...

British Journal of General Practice, 2020

BackgroundIn the predictD-intervention, GPs used a personalised biopsychosocial programme to prev... more BackgroundIn the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant.AimTo determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety.Design and settingSecondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012.MethodIn each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months.ResultsA total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligib...

Frontiers in Psychology, 2021

Various health settings have advocated for involving patients and members of the public (PPI) in ... more Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from thi...

Clinical Psychology Review, 2020

General rights Copyright and moral rights for the publications made accessible in the public port... more General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

BMJ Open, 2021

IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than... more IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents.MethodA systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer...

Revista de Neurología, 2020

PLOS ONE, 2019

Background The predictD intervention, a multicomponent intervention delivered by family physician... more Background The predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions.

BACKGROUND There is a high prevalence of children and young people (CYP) experiencing mental heal... more BACKGROUND There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. OBJECTIVE This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. METHODS A literature search was performed in the Cochrane Library, Excerpt...

PLOS ONE, 2018

Since the use of language is a core aspect of psychotherapy, its study requires instruments that ... more Since the use of language is a core aspect of psychotherapy, its study requires instruments that allow for further research. The aim of this study is to present an observational instrument capable of analyzing the language used in psychotherapeutic settings, both by therapists and clients. The SICOLENTE instrument was applied to two different samples: The Three Approaches to Psychotherapy film and a naturalistic sample. 7710 utterances from 31 sessions (three from the demonstration film and 28 from a naturalistic setting) were coded. Two studies were conducted: in the first study, inter and intra coder reliability (dimension and category levels) and Generalizability theory analyzes were assessed, whilst in the second study, construct validity was tested with several hypotheses. The final instrument resulted in 20 categories with three dimensions: Conversational Act (7 categories), Therapeutic topic (6 categories) and Content (7 categories). The three dimensions showed excellent inter and intra coder reliability and the generalizability coefficients were excellent. Out of the 24 validity hypothesis proposed,19 were accepted. The finding suggests that the SICO-LENTE is a reliable and valid instrument that can be applied to investigate the performance of various theoretical models. Its three dimensional structure gives it the flexibility to be able to carry out macroscopic or microscopic language research.

BMJ Open, 2018

IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing... more IntroductionAlthough evidence exists for the efficacy of psychosocial interventions in preventing depression, little is known about its prevention through online interventions. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials assessing the effectiveness of online interventions in preventing depression in heterogeneous populations.Methods and analysisWe will conduct a systematic review and meta-analysis of randomised controlled trials that will be identified through searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Australia New Zealand Clinical Trials Register . We will also search the reference lists provided in relevant studies and reviews. Experts in the field will be contacted to obtain more references. Two independent reviewers will assess the eligibility criteria of all articles, extract data and determine their risk of bias (Cochrane Collabo...

PLOS ONE, 2018

Background Empirical evidence has shown that cardiac rehabilitation programs are effective in red... more Background Empirical evidence has shown that cardiac rehabilitation programs are effective in reducing morbidity and mortality, improving quality of life in patients with cardiovascular disease. Despite the benefits, women have a high cardiac rehabilitation dropout rate. Our aim was to explore women's perceptions about the reasons they faced for dropout from these programs. Methods Semi-structured interviews were conducted with women (n = 10) after dropping out from three different cardiac rehabilitation centers in Spain. In addition, a focus group and a semistructured interview with cardiovascular professionals were conducted. From a grounded theory perspective, thematic analysis was used to derive themes from interview transcripts. Results The women were between 41 and 70 years. We identified five general themes that illustrated reasons for cardiac rehabilitation dropout: intrapersonal reasons (self-reported health, self-reported mental health, health beliefs); interpersonal reasons (family caregiver role, work conflicts); logistical reasons (transport, distance); cardiac rehabilitation program characteristics (perception of the objective of cardiac rehabilitation, exercise component, inconvenient timing, cardiac rehabilitation equipment); and health system reasons (financial assistance for transport, long waiting list). The cardiovascular professionals found barriers to cardiac rehabilitation completion similar to those found by the women. Conclusions In order to prevent cardiac rehabilitation dropout in women, modular and flexible programs are needed. In addition, the inclusion of primary care centers or community resources could

BMC public health, Jan 13, 2018

Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ide... more Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficien...

BMC public health, Jan 13, 2018

It has been highlighted the original article (1) contained a typesetting mistake in the authorshi... more It has been highlighted the original article (1) contained a typesetting mistake in the authorship, and that author Caterine Vicens was omitted.

BMJ quality & safety, Jan 15, 2018

Copayment policies aim to reduce the burden of medication expenditure but may affect adherence an... more Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. A population-based study was conducted using real-world evidence. Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. Before changes to copayment policies, IMNA prev...

BMC medicine, Feb 23, 2018

Depression is viewed as a major and increasing public health issue, as it causes high distress in... more Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention i...