Escala de convivencia con un proceso crónico: estudio piloto en pacientes con enfermedades crónicas

ObjectiveTo present the pilot study of the Living with Chronic Illness Scale (EC-PC) in patients with diabetes mellitus type 2, chronic heart failure, chronic obstructive pulmonary disease and osteoarthritis.DesignObservational, cross-sectional and multicenter study.LocationTwo specialized hospitals in Navarre and Madrid.Participants64 patients with several chronic diseases, older than 18 years old, that go to primary health centre and/or outpatients. Patients with cognitive deterioration and/or psychiatric disorders were excluded.InterventionsEvaluations had an average duration of 15 minutes per patient.Main measurementsPatients completed the EC-PC and a questionnaire related to the scale. Feasibility/acceptability, internal consistency and construct validity was analyzed.ResultsFor the total sample, the EC-PC showed a good viability and acceptability, without missing data and with almost 100% of the computable data. Cronbach's alpha coefficient reached values between 0.64 and 0.76, and the homogeneity index was higher than 0.30 in all domains of the scale. The values of internal validity ranged between 0.04 and 0.30. No significant differences were found (p> 0.05) in the total score of the scale according to gender or the different pathologies. The patients described the scale as simple and useful.ConclusionsThe pilot study of the EC-PC in patients with different chronic illnesses showed that it is a brief, easy to use, reliable and valid measure. The EC-PC will serve to know in an individualized way, how the patient is living with his/her chronic process and to prevent possible negative aspects of the daily living with the disease.     

Evaluación de la efectividad de los programas de vacunación

Vaccines have contributed enormously to reducing the incidence of many communicable diseases. The protective efficacy of a vaccine refers to the health effects of the vaccine applied in optimal, ideal conditions, whereas the effectiveness of a vaccination program refers to the health effects of vaccination in the vaccinated individuals in clinical practice or within public health programs, which may differ widely from optimal conditions. Vaccine efficacy is estimated by randomized clinical trials. In contrast, effectiveness can be measured by various types of epidemiological studies: randomized community trials, in which the target vaccine is randomly assigned to a group and disease incidence in this group is compared with that of an unvaccinated group; cohort studies, which are observational epidemiological studies in which the vaccination status is known in healthy vaccinated (vaccinated cohort) and unvaccinated (unvaccinated cohort) people and the occurrence of the disease in the two groups is studied; and observational case-control studies, in which two groups are selected; one with the disease under investigation (cases) and the other without (controls), and vaccination histories are investigated in the two groups. Vaccine effectiveness may also be estimated by comparing attack rates in epidemic outbreaks or secondary attack rates in the home, or by screening.     

Evaluación de la efectividad de un programa de atención integrada y proactiva a pacientes crónicos complejos

Objective

To assess the effectiveness of a proactive and integrated care programme to adjust the use of health resources by chronic complex patients (CCP) identified as potential high consumers according to a predictive model based on prior use and morbidity.

Equidad y autonomía del paciente en las estrategias de atención a personas con enfermedades crónicas en los servicios de salud de España

ObjectiveTo examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components.MethodNarrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments’ web pages, using the terms “Programmes”, “Strategies”, “Chronic patients”, and “Chronicity”.Results15 programmes were found. Most of them include all components of the chronic care model, “decision-making support” being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease.ConclusionsChronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease.     

Evolución de las hospitalizaciones potencialmente evitables por condiciones crónicas en España

ObjectiveTo analyse the trend in potentially avoidable hospitalisations (PAH) in frail patients or those with chronic conditions in Spain during the period 2002-2013.MethodsAn observational, ecological study was conducted to analyse the trend in age-sex standardised rates of PAH affecting six clinical conditions, and their variation, in the 203 health care areas composing the publicly-funded health system in Spain.ResultsDuring the period 2002-2013, overall PAH standardised rates decreased by 35%, but systematic variation remained moderately high, around 13% above that expected by chance. Angina admissions showed the largest reduction, followed by those for asthma and chronic obstructive pulmonary disease. In contrast, the prevalence of admissions for dehydration doubled.ConclusionsDespite the decrease in PAH rates, systematic variation among areas remains, indicating differences in chronic care management that lead to distinct healthcare outcomes.     

Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos

ObjectiveTo create a scale and tool that allows us to measure the fragility of the chronic patient.DesignObservational study on the area's chronicles.LocationBetween January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet.ParticipantsFragile subjects of the North Sanitary Area of Malaga.InterventionDesign and validation of a scale.Main measurementsStudy variables. Main outcome variable: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological.Accessibility outcome variables were used as prediction variables.Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size.ResultsFrom the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used.ConclusionsIt was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. Conclusions: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.