83% of the total population of Catalonia was attended to by primary care last year, more than half a million people (21%) more than in 2019. But if in that pre-pandemic year face-to-face visits represented 84% of total, now they are 58%, and the rest (42%) are telephone or telematic services. These are data that appear in the Results Center, a report that compiles 257 indicators of the Catalan health system in recent years.
If the impact of covid has meant a before and an after, there are things that do not change, and access to primary care and hospital emergency services remain two of the great deficits of an organization that can also improve in sections such as excessive medicalization or the number of avoidable hospitalizations: one in six.
The data, which can be consulted on the website of Aquas (Agency for Health Quality and Assessment of Catalonia), reflects the situation of the system and will serve to guide the policies of the Generalitat. “This instrument gives us absolute transparency of what is happening, tools to make decisions and also elements to compare what is happening throughout the territory”, said the health minister, Manel Balcells. The indicators can be compared by territory, health centers or by characteristics of the population, such as socio-economic level, sex or age.
With 7.6 million citizens assigned, primary care made 59.9 million visits in 2022 (2.8% more than in 2019), an average of 7.8 visits per person. Frequency increases significantly among users aged 20 to 55, people of working age. But the loyalty and satisfaction index of primary care users has fallen by 6% since 2018, while it remains at high levels in other healthcare environments, such as hospitals or intermediate care. According to the experts, the difficulties in obtaining a face-to-face visit with the reference professional, interpreted as a difficulty of access, decisively influence the negative assessments. Contrary to what happens with the staff at the desk, the treatment of the optional and nursing professionals continues to present a very high score.
Doctors’ offices prescribe too many: 150.6 million prescriptions last year (7.8% more than in 2019), 19.4 for each user. “A part, perhaps important, of this consumption may not be necessary”, it may even be harmful in some cases, experts warn: 143,000 patients are being treated with proton pump inhibitors without gastroprotection criteria (the half of those taking PPIs for more than 3 months), 73,430 people at low cardiovascular risk were given lipid-lowering drugs, more than half of adults with pharyngitis were prescribed antibiotics without a diagnosis of bacterial pharyngitis, 36,677 older adults with a anxiety incident were prescribed long-term benzodiazepines… One in five people over 75 take 10 or more drugs regularly: Drug spending is age-related, but also seen a relationship with socioeconomic level: the lower, the more medication.
In terms of hospital activity, it has been recovering from the depression of the pandemic thanks essentially to the growth of major ambulatory surgery. The number of hospital discharges stands at 925,898 (2.3% more than in 2019) and the average stay remains at 6.4 days. Users are quite satisfied: 9 out of 10 would repeat admission to the same hospital.
But the emergency rooms, described as “the Achilles’ heel of the hospital sector”, do not raise their heads. There has been no reduction in emergencies considered less serious (61.2%) nor in the percentage of patients admitted to the emergency room for more than 24 hours (19%). 70.5% of hospital income comes from the emergency service – when experts estimate the maximum at 60% -, which “has a considerable impact on the operation of the hospital, as it aggravates the availability of beds for to the scheduled activity, very directly related to the waiting lists for surgical procedures”, another of the system’s structural weaknesses.
On the other hand, the Results Center reflects a notable increase in the mental health and addictions section. The 75 adult mental health centers treated 180,881 people (2.8% of the population) in 2022. Depression (20%) was the most frequent diagnosis. Outpatient child and youth care services treated 72,005 minors (5.7% of the Catalan census), an increase of 9% compared to 2020, with neurodevelopmental disorders as the main diagnosis. Drug addiction care centers reported 12,367 withdrawals last year (8% more than in 2021), with alcohol as the most common reason, followed by cocaine and heroin.
