Primary Care, the axis "without resources" of de-escalation

Health now requests the ability to test the autonomous communities . This requirement did not appear in the BOE issued yesterday morning so that each community could send their status reports to enter each of the new phases of de-escalation. Almost two months after the crisis, it is paradoxical that this issue should arise, when it is a necessary indicator that they have been demanding for some time from primary care, the axis on which Health wants to rely on de-escalation.

Thus, at least, Salvador Illa, the person in charge of the health portfolio, has stated it on more than one occasion, and who yesterday recalled that " we must strengthen the capacities of primary care " in the tasks of early diagnosis and surveillance of the epidemic . Because the same Fernando Simón, director of the Center for Health Alerts and Emergencies, expressed that the new objective of Health is to identify new cases in about 48 hours instead of the current more than six days . "It is a very ambitious goal that we will see little by little if possible in the areas that are transitioning to phase one," admitted Simon. For this, it is necessary to know what tools are available. Hence the recent request to the autonomies.

For this reason, Illa hopes not to repeat the errors of the beginning of the crisis to increase the ability to do PCR and other tests , and to Primary Care. However, its protagonists know little about this plan. "We know that we are going to be linked to Public Health, to Health Departments, but little else, " says José Llisterri, President of Semergen (Spanish Society of Primary Care Physicians). Who points out that they continue to maintain the claims in order to be more operational: more tests, more human resources ... " Although there are communities that have already taken the first steps, there is a lack of generalization in all of them, " emphasizes Llisterri, who recalls that not only " It is about identifying and caring for Covid-19 patients, but to recover the follow-up of the rest of chronic diseases ”.

In this sense, from the Spanish Society of Family and Community Medicine (Semfyc), José María Molero, from the Infectious Diseases Working Group, warns that “not only are resources needed. It must also be clear what tests we are going to carry out and why, what are the circuits we need so as not to mix the SARS-CoV-2 suspects with the rest ». Molero is correct in pointing out that, although “ there is an epidemiological surveillance model for influenza, why not export it in this pandemic . We would have sentinel services that we could take advantage of and that would serve as an alert in case of outbreaks. ”

Health made it clear yesterday, after the Interterritorial Council, that it will be essential to strengthen detection capacity through primary care, using PCR tests or other equivalent diagnostic techniques , and that health centers carry out surveillance and identification of all close contacts. He also stressed that epidemiological surveillance systems should provide daily information on the evolution of the pandemic for decision-making, with new indicators and with a detailed level of disaggregation that allows rapid reactions to be taken in the event of new outbreaks.

From Semfyc, Molero adds one more actor to the equation that Health proposes: « I think we should have more relationship and coordination with Occupational Health , in addition to Public Health. We have to eliminate the watertight compartments and establish circuits in addition to the hospitals, as up to now, with the emergency services and labor services ”. With this, the doctor ensures that the patient's follow-ups and their closer contacts are better tightened.

This puts outpatient professionals in the dichotomy of the supposed return to normality and epidemiological surveillance , “although I do not like this concept, we must be clear that we cannot assume more workload than already exists either. We have already exercised control and referral of cases before. So we couldn't do the tests because we didn't have them, "recalls Llisterri.

Now, the almost million patients that Semfyc assures that they have followed at home could be susceptible to undergoing a test . "Until now, we made diagnoses based on the clinic," recalls Molero. Who does not hesitate to claim that, if speed is requested and to be more precise with control, "why are telemedicine or m-health tools not being better used ?" Simón, in this sense, commented on the possibility of using mobile applications for this, as other countries do to control these contacts , which must first be assessed what they contribute from a health perspective and whether they can be integrated with the bases of data.

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