Background The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. Objective To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. Methods/design This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Population Patients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. Sample size n = 1148 patients (574 per study arm). Intervention Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. Outcomes The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. Statistical analysis The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. Discussion It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. Trial registration ClinicalTrials.gov NCT04147130. Registered on 22 October 2019

The TeNDER project aims to improve the quality of life (QoL) of chronic patients through an integrated care ecosystem. This study evaluates the health recommender system (HRS) developed for the project, which offers personalized recommendations based on data collected from a set of monitoring devices. The list of notifications covered different areas of daily life such as physical activity, nutrition, and sleep. We conducted this case study to evaluate the effectiveness and usability of the HRS in providing accurate and relevant recommendations to users. Evaluation process consisted on survey administration for QoL assessment and the satisfaction and usability of the HRS. The four-week pilot study involved several patients and caregivers and demonstrated that the HRS was perceived as user-friendly, consistent, and helpful, with a positive impact on patients’ QoL. However, the study highlights the need for improvement in terms of personalization of recommendations.

BACKGROUND Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between patient and technology, called usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure its relevant role in promoting self-care. OBJECTIVE To analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. METHODS Descriptive observational cross-sectional usability study framed in the clinical trial in Primary Care of Madrid of the TeNDER project. Were included patients over 60 years of age who had one or more chronic disease, at least one of which was mild-moderate cognitive impairment and/or Parkinson’s disease and/or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate. The usability variables that were studied were the effectiveness in usability, which was determined by the degree of completion and the total number of errors per task; the efficiency in usability, evaluated as the average time to perform each task and the satisfaction in usability, quantified by the System Usability Scale (SUS). Five tasks were evaluated based in real case scenarios. Usability variables were described according to sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for tasks completion. RESULTS From the total amount of patients included in the project, 38 agreed to participate. The median age of the participants was 75 years (IQR 72.0-79.0), 20/30 were women (52.6%) and suffered a median of eight chronic diseases (IQR 7.0-11.0). Thirty patients completed the usability study, with a usability effectiveness result of 89.3% (134/150 tasks completed). 66.7% of patients (20/30) completed all tasks and 56.7% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level acted as a facilitating factor for independent task completion (OR 1.79, CI95% 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction was 55 (IQR 45.0-62.5) out of 100. CONCLUSIONS Although usability effectiveness was high, the poor efficiency and usability satisfaction results suggest that there are other factors that may interfere with the results. It has not been possible to show that multimorbidity is a key factor in the usability results of a technological tool.

Background SARS-CoV-2 infection may produce symptoms for longer than 4 weeks (long COVID). Its duration, causes and consequences are still not well known. The objective of this study is to estimate the prevalence of long COVID, its signs and symptoms and the use of resources in adult patients in Primary Care (PC). Methods Observational, descriptive, retrospective case series study performed in PC. Patients older than 18 years who had a positive polymerase chain reaction test for SARS-CoV-2 from February 29th until April 15th, 2020 were included. Variables related to clinical symptoms and use of resources were registered from 4 weeks after the confirmed COVID-19 case notification, up to 39 weeks. Results Mean age of the 267 patients analyzed was 57 years old (16.0 SD) and 55.8% were women. In the acute phase, 61.8% of the patients required hospitalization and 43.8% suffered bilateral pneumonia. Long COVID prevalence found was 45.7% (CI 95% 39.6–51.9), and 53.3% of them had symptoms longer than 12 weeks. Most common symptoms were dyspnea (45.1%, CI 95% 36.1–54.3), asthenia (42.6%, CI 95% 33.7–51.9), cough (24.6%, CI 95% 17.2–33.2), and neuropsychiatric disorders (18%, CI 95% 11.7–26). 98.4% of long COVID patients required contact with PC during follow-up, with an average of 6.7 (5.0 SD) contacts. At least 45.1% had a lab test, 34.4% a chest x-ray and 41.8% required work leave. Factors associated with a higher number of contacts with PC included developing ARDS (IRR 1.7, CI 95% 1.2–2.2), long COVID (IRR 2.9, CI 95% 2.5–3.4), requiring a work leave (IRR 2.4, CI 95% 2.1–2.9), and the need of hospitalization (IRR 1.5, CI 95% 1.2–1.9). Conclusion Almost half of the patients of this study developed long COVID, similar to preceding works. Most frequent persistent symptoms were dyspnea, asthenia, and cough. Use of resources such as lab tests, chest x-rays, work leaves, PC appointments and hospital referrals, was two to six times greater among long COVID patients, in contrast with those who did not develop long COVID. Requiring hospitalization and having a severe disease at onset was associated to a higher number of PC contacts.