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Fernández Bosch A, del Campo Giménez M, Hermida Lazcano I, Rodríguez Marín Y, Camarena Navarro L, Párraga Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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Fernández Bosch A, del Campo-Giménez M, Hermida-Lazcano I, Rodríguez-Marín Y, Camarena Navarro L, Párraga-Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo-Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida-Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez-Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga-Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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Burgos Díez C, Sequera Requero RM, Ferrer Costa J, Tarazona-Santabalbina FJ, Monzó Planella M, Cunha-Pérez C, Santaeugènia González SJ. Study of a Quasi-Experimental Trial to Compare Two Models of Home Care for the Elderly in an Urban Primary Care Setting in Spain: Results of Intermediate Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2329. [PMID: 35206517 PMCID: PMC8872333 DOI: 10.3390/ijerph19042329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Functional dependence is associated with an increase in need for resources, mortality, and institutionalization. Different models of home care have been developed to improve these results, but very few studies contain relevant information. This quasi-experimental study was conducted to evaluate two models of home care (HC) in a Primary Care setting: an Integrated Model (IM) (control model) and a Functional Model (FM) (study model). MATERIAL AND METHODS Two years follow-up of patients 65 years old and older from two Primary Health Care Centres (58 IM, 68 FM) was carried out, recruited between June-October 2018 in Badalona (Barcelona, Spain). Results of the mid-term evaluation are presented in this article. Health status, quality of care, and resource utilization have been evaluated through comprehensive geriatric assessment, quality of life and perception of health care scales, consumption of resources and complementary tests. RESULTS A significant difference was detected in the number of hospital admissions (FM/IM 0.71 (1.24)/1.35 (1.90), p: 0.031) in the Accident and Emergency department (FM/IM 2.01 (2.12)/3.53 (3.59), p: 0.006) and cumulative days of admission per year (FM/IM 5.43 (10.92)/14.69 (20.90), p: 0.003). CONCLUSIONS FM offers greater continuity of care at home for the patient and reduces hospital admissions, as well as admission time, thereby saving on costs.
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Affiliation(s)
- Carolina Burgos Díez
- Primary Health Care Centre Passeig Maragall, Institut Català de la Salut, 08041 Barcelona, Spain;
| | | | - Jose Ferrer Costa
- Primary Health Care Centre Apenins, Badalona Serveis Assistencials, 08917 Badalona, Spain;
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, 46600 Alzira, Spain;
- Medical School, Catholic University of Valencia, Sant Vicent Màrtir, 46001 Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
| | - Marià Monzó Planella
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain;
| | - Cristina Cunha-Pérez
- Faculty of Nursing, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Sebastià Josep Santaeugènia González
- Central Catalonia Chronicity Research Group (C3RG), University of Vic, Central University of Catalonia, 08500 Vic, Spain
- Chronic Care Program, Ministry of Health, Generalitat de Catalunya, 08028 Barcelona, Spain
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Burgos-Díez C, Sequera-Requero RM, Tarazona-Santabalbina FJ, Contel-Segura JC, Monzó-Planella M, Santaeugènia-González SJ. Study protocol of a quasi-experimental trial to compare two models of home care for older people in the primary setting. BMC Geriatr 2020; 20:101. [PMID: 32164542 PMCID: PMC7068968 DOI: 10.1186/s12877-020-1497-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preventive home visits are suited for patients with reduced mobility, such as older people. Healthcare needs for older patients are expected to increase due to the extended life expectancy estimated in coming years. The implementation of low-cost, patient-centered methodologies may buffer this rise in health care costs without affecting the quality of service. In order to find the best home care model with less investment, this paper describes a study protocol comparing two models of home care for older people. METHODS We describe a quasi-experimental study that compares the outcome of two different home care models already implemented in two primary care centers in Badalona (Barcelona, Spain). The traditional model (control model) is integrated in the sense that is continuous, the same primary care center team looks after its assigned patients both at the center and in preventive home visits. The new functional home care model (study model), consisting of a highly trained team, is specifically designed to meet patient needs and give total attention to preventive home interventions. The study will start and end on the expected dates, June 2018 to October 2020, and include all patients over 65 years old already enrolled in the home care programs of the primary care centers selected. The primary endpoint assessed will be the difference in hospitalization days between patients included in both home care programs. Other variables regarding health status, quality of care and resource utilization will also be compared between the two models. DISCUSSION The study in progress will assess whether a functional and highly trained home care team will meet the ever-aging population needs in terms of cost and health outcomes better than a traditional, integrated one. Lessons learned from this pilot study will provide guidelines for a future model of home care based on the IHI Triple Aim: better care, better health, and lower costs. TRIAL REGISTRATION Registered in ClinicalTrials.gov (Identifier: NCT03461315; March 12, 2018).
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Affiliation(s)
- Carolina Burgos-Díez
- Department of Surgery and Surgical Specializations, Faculty of Medicine, University of Barcelona (PC 08036), Barcelona, Catalonia Spain
- Primary Care Center Apenins, Badalona Serveis Assistencials, Badalona, Catalonia Spain
| | | | | | | | - Marià Monzó-Planella
- Department of Surgery and Surgical Specializations, Faculty of Medicine, University of Barcelona (PC 08036), Barcelona, Catalonia Spain
| | - Sebastià Josep Santaeugènia-González
- Chronic Care Program, Ministry of Health, Barcelona, Catalonia Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Societal Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500 Vic, Spain
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González-Ortega M, Gené-Badia J, Kostov B, García-Valdecasas V, Pérez-Martín C. Randomized trial to reduce emergency visits or hospital admissions using telephone coaching to complex patients. Fam Pract 2017; 34:219-226. [PMID: 27920119 DOI: 10.1093/fampra/cmw119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity remains a matter of international interest, given growing prevalence of chronic conditions. OBJECTIVE To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing resource consumption and improving health status, caregiver burden and quality of life among complex chronic patients (CCP) compared with usual care. METHODS A randomized controlled trial was conducted on a random sample of CCP from three primary care teams in Barcelona. Patients were randomly allocated into intervention or control groups. Evaluations were conducted at baseline and after six-month follow-up. Intervention patients were phoned twice a month by a family physician. Both groups received usual care. Primary endpoint was change in total number of urgent visits per patient. Secondary endpoints were changes in health and mental status, quality of life and caregiver burden. RESULTS Hundred and sixty-one CCP were included. During follow-up, 9 patients died and 2 were lost. At baseline, patients' characteristics and resource consumption were similar for both groups. After six months, urgent visits per patient decreased in intervention (1.27 baseline versus 0.89 follow-up, P = 0.091) and control (1.06 baseline versus 0.86 follow-up, P = 0.422) groups, mean difference 0.18 [confidence interval (CI) 95% -0.48 to 0.84]. Intervention patients improved in the physical component of the SF-12 questionnaire, while worsening in control patients, mean difference 4.71 (CI 95% -9.03 to -0.41). Differences were not found in the rest of the endpoints. CONCLUSION The intervention did not reduce urgent visits among CCP neither improved patient's health.
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Affiliation(s)
| | - Joan Gené-Badia
- Institut Català de la Salut, Barcelona, Spain.,Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.,Medicine Department, University of Barcelona, Barcelona, Spain
| | - Belchin Kostov
- Transverse group for research in primary care, IDIBAPS, Barcelona, Spain
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Corrales-Nevado D, Palomo-Cobos L. La importancia de la longitudinalidad, integralidad, coordinación y continuidad de los cuidados domiciliarios efectuados por enfermería. ENFERMERIA CLINICA 2014; 24:51-8. [DOI: 10.1016/j.enfcli.2013.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/29/2013] [Indexed: 10/25/2022]
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Predictors of mortality among elderly dependent home care patients. BMC Health Serv Res 2013; 13:316. [PMID: 23947599 PMCID: PMC3765804 DOI: 10.1186/1472-6963-13-316] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/29/2013] [Indexed: 12/18/2022] Open
Abstract
Background The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. Results 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care.
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Cayuelas Redondo L, Navarro González M, Kostov B, Sisó Almirall A. Baja comorbilidad en longevos. Aten Primaria 2013; 45:330-2. [PMID: 23411162 PMCID: PMC6983558 DOI: 10.1016/j.aprim.2012.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Laia Cayuelas Redondo
- Medicina de Familia y Comunitaria, Centro de Salud Casanova, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
- Autor para correspondencia.
| | - Marta Navarro González
- Medicina de Familia y Comunitaria, Centro de Salud Comte Borrell, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Belchin Kostov
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
- Medicina de Familia y Comunitaria, Centro de Salud Les Corts, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
| | - Antoni Sisó Almirall
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
- Medicina de Familia y Comunitaria, Centro de Salud Les Corts, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
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¿Se pueden reducir los ingresos hospitalarios de pacientes incluidos en Programas de Atención a Domicilio? Med Clin (Barc) 2012; 139:487-8. [DOI: 10.1016/j.medcli.2012.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/19/2022]
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