[Methodological aspects of integrated care pathways]

An Integrated Healthcare Pathway (PAI) is a tool which has as its aim to increase the effectiveness of clinical performance through greater coordination and to ensure continuity of care. PAI places the patient as the central focus of the organisation of health services. It is defined as the set of activities carried out by the health care providers in order to increase the level of health and satisfaction of the population receiving services. The development of a PAI requires the analysis of the flow of activities, the inter-relationships between professionals and care teams, and patient expectations. The methodology for the development of a PAI is presented and discussed in this article, as well as the success factors for its definition and its effective implementation. It also explains, as an example, the recent PAI for Hypoglycaemia in patients with Type 2 Diabetes Mellitus developed by a multidisciplinary team and supported by several scientific societies.

Grado de satisfacción de los profesionales de Atención Primaria con un modelo de actividad especializada basado en la consultoría

OBJECTIVE

To evaluate the degree of satisfaction of primary health care workers with a model of specialty care based on consultancy.

METHODS

A questionnaire was delivered to the nurses and physicians of a Primary Care centre, in order to assess their satisfaction with the different activities in the specialty of endocrinology (1-5 points).

RESULTS

The consultancy activity itself was given 4.41 +/- 0.89 points by the nurses (n = 39) and 3.60 +/- 0.97 by physicians (n = 32) (p < 0.05), clinical sessions, 4.21 +/- 0.74 and 3.82 +/- 1.02, and diagnostic and therapeutic protocols, 4.12 +/- 0.71 points (physicians) (p < 0.05 vs consultancy). Global scores was 4.33 +/- 0.70 and 3.76 +/- 0.89 points, respectively. 74% and 80% of the nurses and 58% and 69% of the physicians considered the present model appropriate for other specialties and primary care center, respectively.

CONCLUSIONS

The health care workers at the primary care center assesse show a high degree of satisfaction with this model of specialised care based on consultancy.

Evaluación del proceso y los resultados de la atención a los pacientes diabéticos en un hospital

For the purpose of establishing a specific information system in order to identify the diabetic patients looked after in the hospital and evaluate the processes and the clinical outcomes obtained, a prospective descriptive study was designed--in the Corporació Parc Taulí of Sabadell (Barcelona)--about the diabetic patients cared starting in January 1998, through a clinical registry and other hospital sources of information. Seven hundred and fifty-five patients were identified, and the completeness of the registry was 98%. It was feasible the integration of the registry of admissions with that of the laboratory, that of the discharges from hospital, that of pharmacy and the specific clinical registry. An evaluation of the glycemic control was made in around 90% of the patients, and the registry of the organic explorations was higher than 87%. Although it was not possible in this study, the incorporation of the information from the primary care would complete the follow-up of the patients.