Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

Consequences of the Covid-19 pandemic on complex multimorbid elderly: Follow-up of a community-based cohort. SAMAC3 Study

BACKGROUND

The restrictions imposed during the management of the pandemic led to lack of care of other health problems.

PURPOSE

To assess changes in the health status of complex multimorbidity elderly, functional and cognitive capacities, perception of the social surroundings, care provided by the nurses, including nursing diagnosis and interventions, use of health services, adverse events, and use of devices and technical help during the first 6 months of the Covid-19 pandemic.

DESIGN

A 1-year longitudinal cohort study was conducted.

METHODS

Ninety-seven complex multimorbid elderly attended in primary care were evaluated every 3 months in a health area of the Spanish National Health System (SNHS). The research was called "SAMAC3 study".

RESULTS

Significant negative changes were observed in the functional and cognitive capacity of the elderly, and in several nursing diagnoses. A decrease was observed in the frequency of visit to the nurses, hospital admittance, length of hospital stays, and falls.

CONCLUSIONS

The functional and cognitive capacities of the cohort became worse. However, a significant decrease in the frequency of use of health services was observed. The nurses detected significant changes in activity-exercise, cognitive-perception, and roles-relationships, but their interventions were mostly centered on resolving clinical matters that required immediate attention.

CLINICAL RELEVANCE

The present study allowed us to observe that a situation of social and health stress has worsened the health indicators of multimorbid elderly, and the clinical care of community nurses was insufficient to providing care for the deterioration of the physical and cognitive domains.

How is the nursing activity shown by the Spanish regional health ministries?

OBJECTIVE

To analyse the nursing records and the results of their activity published by the Spanish regional health ministries.

METHOD

Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to "nursing/nurse/midwife" was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed.

RESULTS

Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in "PDF" format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care.

CONCLUSIONS

The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.

Components of case management in caring for patients with dementia: a mixed-methods study

BACKGROUND

Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers.

METHODS

Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register.

DISCUSSION

This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.

Results of Nurse Case Management in Primary Heath Care: Bibliographic Review

BACKGROUND

The new characteristics of today's population, together with the presence of chronic diseases in the elderly, require a new approach to care, promoting coordination between different levels of care. In this sense, we find the figure of the nurse case manager (NCM) in primary health care mainly responsible for ensuring continuity of care in complex patients with chronic diseases.

OBJECTIVE

to describe the role of the NCM in care management, determining its effectiveness in addressing chronic disease (health outcomes and quality of life) and its efficiency in the health system.

METHODS

Bibliographic review of scientific evidence on case management applied to nursing. Between March and April 2020 a bibliographic search was carried out in the Dialnet, Scielo, Scopus and Pubmed databases.

INCLUSION CRITERIA

articles written in the last 5 years, which analyze how this nursing rol influences the care and health of patients.

RESULTS

A total of 16 articles were selected. The NCM reduced the use of the emergency department, hospital admissions, readmissions, and the duration of these in the patients studied.

CONCLUSION

The NCM is effective and efficient for both patients and health institutions, and a common practice model is needed that includes standardized protocols and evidence-based practices.

Impact of the Case Management Model through Community Liaison Nurses

The objective of the present study is to assess the model’s impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002–2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators’ tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients’ clinical condition as well as in the quality and efficiency of care.