Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

Background: Chronic obstructive pulmonary disease (COPD) in nonsmokers is increasingly recognized, yet its clinical profile and outcomes remain less well defined compared to smoking-related COPD. The aim of this study was to compare the clinical characteristics, comorbidities, and risk factors associated with severe exacerbations in nonsmoking COPD patients versus smokers. Methods: We conducted a prospective cohort study including 2376 patients with a diagnosis of COPD from the Lleida Health Region (Catalonia, Spain). Patients were followed for 2 years (2021–2022). Severe exacerbation was defined as hospital admission due to worsening COPD symptoms. Clinical variables were collected at baseline, and logistic regression analysis was performed to identify risk factors for severe exacerbation in the COPD-NS subgroup. Results: A total of 2376 COPD patients were included, of whom 966 (40.7%) were never-smokers. During the two-year follow-up, 165 patients (6.9%) required hospitalization for a severe exacerbation, nearly half of whom were never-smokers (48.5%). In multivariate analysis restricted to COPD never-smokers, the following independent predictors of hospitalization were identified: atrial fibrillation (OR: 2.35; 95% CI: 1.37–3.93), bronchiectasis (OR: 1.91; 95% CI: 1.08–3.28), and lower lung function measured by FVC (OR: 0.64; 95% CI: 0.45–0.89) and FEV1/FVC ratio (OR: 0.64; 95% CI: 0.45–0.89). Female gender was associated with a lower risk (OR: 0.44; 95% CI: 0.21–0.88). The predictive model demonstrated moderate discrimination (AUC = 0.71). Conclusions: COPD-NS patients represent a large proportion of the COPD population and present distinct clinical features. Although the incidence of severe exacerbation is similar to that of smokers/ex-smokers, risk factors such as atrial fibrillation and bronchiectasis have a stronger impact in this subgroup. Early identification of these factors may help guide more targeted clinical management strategies.

Background: Lower respiratory tract infections (LRTIs) are a significant cause of primary care consultations. Differentiating between viral and bacterial infections is critical for effective treatment and to minimize unnecessary antibiotic use. This study investigates the impact of combining lung ultrasound (LUS) with capillary blood C-reactive protein (CRP) rapid testing on clinical decision-making for patients with LRTIs. Objectives: The primary objective is to assess how the integration of CRP testing and LUS influences antibiotic prescription decisions. The study aims to quantify the percentage change in antibiotic prescriptions before and after performing LUS, following history taking, clinical examination, and CRP testing. Methods: This analytical observational study will be conducted in six primary care centers within the Health Region of Lleida, Catalonia, serving a mixed urban and rural population of approximately 105,000 residents. The study will recruit 196 patients aged 18 and over, presenting with LRTI symptoms and not treated with antibiotics in the preceding 14 days. Participants will undergo CRP testing followed by LUS during their consultation. Statistical analyses, including linear regression, bivariate analysis, Pearson or Spearman correlation, and logistic regression, will be used to evaluate the impact of LUS on clinical decisions and its predictive value in diagnosing bacterial infections. Results and Conclusions: This study will provide insights into the role of LUS combined with CRP testing in improving diagnostic accuracy and guiding antibiotic prescription decisions in primary care. The findings aim to enhance treatment protocols for LRTIs, reducing unnecessary antibiotic use and improving patient outcomes.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a heterogeneous syndrome with substantial variability in clinical progression and survival. Although neutrophil-to-lymphocyte ratio has been widely studied, evidence regarding neutrophil-to-monocyte plus lymphocyte ratio (NMLR) remains limited. This study evaluated whether baseline peripheral blood neutrophil-to-monocyte plus lymphocyte ratio (NMLR), a composite marker of systemic inflammation, was independently associated with long-term all-cause mortality in patients with COPD managed in primary care. Methods: We conducted a retrospective population-based cohort study using electronic health records from the Lleida Health Region (Spain) between 1 January 2014 and 31 December 2023. Patients with spirometry-confirmed COPD and available baseline complete blood counts were included. Baseline NMLR was calculated as (absolute neutrophil count + absolute monocyte count)/absolute lymphocyte count using the first valid blood sample obtained after cohort entry. Patients were categorized into NMLR quartiles. Associations with all-cause mortality were assessed using multivariable Cox proportional hazards regression models adjusted for age, sex, smoking status, lung function, and baseline comorbidity burden. Results: A total of 2644 patients were included, contributing 19,231 person-years of follow-up. During a median follow-up of 8.8 years, 1085 deaths occurred. Mortality increased progressively across NMLR quartiles, from 28.3% in the lowest quartile to 60.2% in the highest quartile. In fully adjusted analyses, patients in the highest quartile had higher all-cause mortality than those in the lowest quartile (hazard ratio [HR] 2.00; 95% confidence interval [CI] 1.66–2.40; p < 0.001). When modeled continuously, each doubling of baseline NMLR was associated with a 34% increase in mortality risk (HR 1.34; 95% CI 1.26–1.42). Conclusions: Elevated baseline NMLR was independently associated with increased long-term mortality in COPD. As an inexpensive and routinely available inflammatory biomarker, NMLR may improve mortality risk stratification and support future evaluation of risk-stratified follow-up strategies in primary care. External validation is required before implementation in routine clinical practice.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide and a systemic condition in which outcomes are influenced by respiratory impairment, multimorbidity, exacerbation burden, and functional status. This study aimed to identify multidimensional determinants of all-cause mortality in a population-based cohort of primary care patients with spirometry-confirmed COPD. Methods: We conducted a retrospective population-based cohort study using electronic health records from primary care in the Lleida health region (Catalonia, Spain). Adult patients with spirometry-confirmed COPD (FEV1/FVC < 0.70) between 2019 and 2023 were included. Baseline demographic, clinical, spirometric, functional, and social variables were extracted. Exacerbations in the year prior to baseline were classified as 0, 1, or ≥2 events (and, where available, as moderate vs. severe) using a prespecified operational definition. The primary outcome was all-cause mortality during follow-up (censoring date: 31 December 2023). Time-to-event analyses were performed using Cox proportional hazards models. Results: A total of 2056 patients were included (median age 71 years; 78.4% male). During follow-up, 558 patients died (27.1%). Independent predictors of mortality included male sex, increasing age, current smoking, and prior exacerbations, whereas sufficient physical activity and better lung function (FEV1 % predicted) were protective. Conclusions: Mortality in spirometry-confirmed COPD managed in primary care is driven by a multidimensional vulnerability profile beyond lung function alone. Integrating respiratory, clinical, and functional determinants may improve risk stratification and management in chronic lung disease.