Objective: To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care.Design: A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/ record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon.Patients: Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain.Methods: Crude and adjusted incremental cost utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed.Results: The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of euro 1,780.75 and an adjusted ratio of euro 851.67 were obtained, indicating that the programme significantly improved patients’ quality of life with a cost-increasing outcome that fell below the costeffectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance.Conclusion: The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.LAY ABSTRACTFollowing the gold standard trial design for evaluating healthcare technologies, a health economic evaluation was conducted on a new multidisciplinary intervention programme for patients with fibromyalgia syndrome in primary care centres in Catalonia, Spain. Estimations of direct healthcare and social costs were assessed jointly with the effect on quality of life, in order to compare the new intervention with usual clinical care. The results showed that the programme proved its cost-utility for society, as patients’ perceived health improvements outweighed the cost increase, according to the maximum price accepted for an extra unit of quality of life in Spain. These findings were verified when cost estimations were corrected with the actual health expenditure. In addition, the intervention implementation scheme demonstrated cost-saving potential by increasing participants’ session attendance to at least 66%. Therefore, patients and society could benefit from this new therapeutic strategy for fibromyalgia if adopted by the regional services portfolio.

We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals’ perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users’ assessment of the care received within the program framework; (6) users’ perception of the impact on health and wellbeing; (7) users’ demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users’ satisfaction with the care received.

Fibromyalgia syndrome (FMS) disrupts patients’ biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia’s primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients’ lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients’ needs, which will hopefully increase its effectiveness and improve their quality of life.

After the end of their time as a caregiver, former caregivers have needs and feelings that have been subject to little study to date. The aim of the study is to determine and analyse the feelings, perceptions and practices of former caregivers in the reconstruction of their daily lives. This is a qualitative study based on the Grounded Theory developed by Charmaz. The study involved 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Fourteen in-depth interviews were conducted and data were collected over 13 months between 2015 and 2017. Data were analysed using the Grounded Theory Method. In addition, this study was approved by the ethics committee of the Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol. The former caregiver experiences a transition, which begins in the days before the death of their relative and may continue for more than 3 years. Three critical moments in the post-caring transition were found: (1) the post-caring emptiness; (2) the end of the period as a caregiver; and (3) the movement towards a new life. Family and professional support is needed during this transition. Former caregivers experience a transition in the rebuilding of their daily lives; furthermore, former caregivers may be a source of support for other caregivers, which is linked to positive mental health factors. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health of former caregivers.

Aim: The aim of this study was to analyze the caregiving experience of parents whose adolescent children with a mental illness require admission to a day treatment hospital for mental health services.Method: The study used qualitative interpretative research methods. A total of 18 parents participated in the semi-structured interviews. Data were then transcribed and analyzed in accordance with established methods for the analysis of inductive thematic data.Results: Seven themes were identified: questioning an unseen disease, abnormal behavior, a long road, truancy and loss of parental authority, internalized stigma on admission, regaining the meaning of life and an uncertain future.Discussion: The experience of the parents was analyzed and various emotional, psychological and interpersonal barriers were found that influenced the help-seeking for the adolescent’s treatment.Implications for practice: Nursing interventions should be based on detecting barriers and validating the experience of parents with mentally ill adolescents.