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Archive for noviembre 2020

During the pandemic we have taken for granted that all of us are digital natives. Nothing could be further from the truth. Only Millennials (1981-1993) and those younger can be considered digital natives; the rest of us need some kind of introduction or training to the digital world.

Now, bring this to the healthcare world. In the EU27, “One third of workers in health and social care are at least 50 years old,” according to Employment in Health and Long-Term Care Sector in European Countries (NEUJOBS Working Documents 2013).

And what about the population at large? “In 2019, more than one fifth (20.3 %) of the EU-27 population was aged 65 and over,” according to Population structure and ageing (Eurostat).

And yet, we assumed that it was easy to emigrate from an analogic care system to a digital one. No wonder most of us are still running around like chickens without a head trying to make sense of it all.

I have heard a lot of praising of the possibilities that the digital world could bring to our everyday lives. Massive investments in ICT; new apps that will change the way we manage our illnesses; gains in efficiency in the care system, etc. Unfortunately, I have not heard of how those 50-year olds and older healthcare practitioners, and those millions of 65s and older are going to be trained to understand and use those wonderful ICT gadgets.

I hope we are not sleepwalking towards a rude awakening in which those massive investments have been dumped in the garbage, because very few people understand their usefulness and even fewer people are prepared to use them.

Maybe there is still time to pause and think: think about the people who have to use the applications. Or maybe, is it simply to think about people?

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Due to the current situation, Primary Care has been brought to the limits of its endurance. This cannot come as a surprise. Most systems are tailored to the current needs that the system has to attend to, not to emergency situations. The job of Primary Care is to attend the day-to-day business of the population, acting as the front door to the health system, and to monitor the evolution of chronic patients.

Covid-19 has added a new dimension to this job description: doing the triage of the population in view of identifying those infected with the virus. It would not be a big problem if that were a normal procedure: anamnesis, decision, and derivation to the appropriate health resource or, as is the case of the flu, a recurrent winter event that can be pre-programmed. But this is not the case. To start with, SARs-CoV-2 is a very infectious virus that occurs throughout the entire year. The fact that it is highly infectious has changed the way the healthcare professional has to confront his/her prospective patient. The professional has to be equipped with Personal Protective Equipment (PPE), the premises have to be disinfected regularly, incoming people have to be pre-checked to avoid unnecessary contagion of personnel and contamination of the premises. All of these procedures necessarily slow the flow of patients precisely when the flow increases due to the pandemic. The result is a bottleneck in the system, and in an attempt to solve it, monitoring of chronic patients is sent to the back of the Primary Care priorities. The system assumes that a chronic patient will not evolve so quickly as to need urgent intervention: just take your medication and hope for the best.

But there is a solution. There are plenty of simple ICT applications to monitor vital signs and other signs like glucose. Unfortunately, we must admit that the biggest barrier to its introduction has come from healthcare professionals. While it is assumed that if the patient needs a medication, the healthcare professional will administer/prescribe it, it is still exceedingly rare that the same professional will prescribe an app. There is no explanation for this dichotomy. How can you explain that a professional will not recommend/prescribe something that is good for the patient and for himself/herself? It saves work for the professional and empowers the patient, allowing the latter more control of the management of his/her condition. There is for sure a long way to go, but the first step in the journey is to convince health professionals of the usefulness of ICT apps, probably using the same procedure that pharmaceutical companies use to introduce their products.

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