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Introduction and objectives: Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function: and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. Participants and method: This is a case-control multicenter study aimed at establishing a well characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (> 10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC < 70%. The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis. (C) 2018 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Introduccion y objetivos Los determinantes en fases iniciales de la historia natural de la enfermedad pulmonar obstructiva cronica (EPOC) son poco conocidos. Entenderlos mejor es de capital importancia para poder disenar intervenciones dirigidas a modificar su pronostico. Los principales objetivos del estudio son: a) caracterizar a una poblacion de adultos jovenes con EPOC de forma multidimensional; b) comparar estos pacientes con sujetos fumadores con funcion pulmonar normal; y c) establecer una cohorte de adultos jovenes con y sin EPOC, que pueda ser seguida a largo plazo para conocer mejor la historia natural de la enfermedad. Participantes y metodo EARLY COPD es un estudio multicentrico de casos y controles que permitira establecer una cohorte de sujetos para su seguimiento posterior. Se seleccionaron 311 (101 casos y 210 controles) participantes reclutados en una treintena de centros de atencion primaria y 12 hospitales de 8 comunidades autonomas espanolas. Los participantes eran fumadores o exfumadores (> 10 paquetes ano) de entre 35-50 anos de edad. Los casos presentaban una espirometria obstructiva con un FEV1/FVC

Objective: To identify the characteristics of chronic patients and their environment in order to predict the nursing workload required 1 year after their inclusion in a home care program. Methods: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain) with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected from each patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer, Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services, self-perceived health (SF-12) and the number of health worker visits. Results: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD 13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender (IRR=1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR=1.65, 95%CI: 1.29-2.13), decubitus ulcers (IRR=4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR=1.65, 95%CI: 1.31-2.07). In contrast, patients with major cognitive impairment (IRR=0.78, 95%CI: 0.63-0.98) had a lower probability of receiving nursing visits at home. Conclusions: Workload can be predicted by patients' clinical characteristics. The positive correlation of workload with variables related to disease severity and the negative correlation with variables related to cognitive impairment show that home care nursing in Catalonia is basically demand-oriented.Objetivo: Identificar las características basales de los pacientes crónicos y su entorno que predicen la carga de trabajo de enfermería durante el año siguiente a su inclusión en un programa de atención domiciliaria (ATDOM). Métodos: Estudio longitudinal realizado en 72 equipos de atención primaria de salud en Cataluña. Seguimiento durante un año de 1068 pacientes de ATDOM mayores de 64 años de edad. Variables recogidas: nivel de salud y situación social (test de Charlson, Barthel, Pfeiffer, Braden y Gijón); sobrecarga del cuidador (Test de Zarit); ingresos hospitalarios y visitas a urgencias; estado subjetivo de salud (SF-12); visitas de los profesionales de salud. Resultados: Los pacientes recibieron 7,2 (DE: 10,4) visitas anuales de su enfermera habitual. Observamos que tienen más riesgo de recibir visitas de enfermería los pacientes varones (IRR=1,42, IC95%: 1,20-1,67), con dependencia para las actividades de la vida diaria (IRR=1,65, IC95%: 1,29-2,13), afectados por úlceras por decúbito (IRR=4,03, IC95%: 2,27-7,14) y que precisaron servicios de atención de urgencia a domicilio (IRR=1,65, IC95%: 1,31-2,07). Por otro lado, los pacientes con deterioro cognitivo importante tienen menos probabilidad de recibir visitas de su enfermera (IRR=0,78, IC95%: 0,63-0,98). Conclusiones: Las características clínicas de los pacientes permiten predecir la carga de trabajo de enfermería. Esta relación positiva de la carga de trabajo con las variables relacionadas con la gravedad de la enfermedad y la relación negativa con el deterioro cognitivo muestra que la enfermería domiciliaria en Cataluña está básicamente orientada a la demanda.

ObjetivoBuscar oportunidades de mejora mediante la evaluación de la atención domiciliaria que ofrecen los equipos de atención primaria en nuestro entorno a las personas > 65 años de edad con enfermedades crónicas. Identificar cuáles son las variables del paciente y del servicio que recibe que se asocian con el deterioro funcional y cognitivo, ingreso en una residencia geriátrica, visita a urgencias, ingreso hospitalario o muerte.DiseñoEstudio analítico de seguimiento de una cohorte durante 3 años.EmplazamientoEquipos de atención primaria de Cataluña.ParticipantesEn total, 1.300 pacientes > 65 años con enfermedades crónicas incluidos en el Programa de Atención Domiciliaria.Mediciones principalesSe recoge anualmente su estado de salud (Charlson, Barthel, Pfeiffer, Braden y Gijón), datos sobre el cuidador (Zarit), atenciones recibidas (social y sanitaria), salud subjetiva (SF-12), visitas a urgencias, ingresos temporales y el resultado final: muerte, ingreso en residencies geriátricas u hospital. Los análisis principales se basarán en regresiones logísticas y una análisis de supervivencia.DiscusiónEl estudio permitirá identificar las características del paciente que tengan valor pronóstico, así como conocer las prácticas de atención social y sanitaria que se asocian con una mejor supervivencia y un menor consumo de recursos sociosanitarios.ObjectivesTo evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities.To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death.DesignAnalytic study of the follow-up of a cohort for 3 years.SettingPrimary health care teams in Catalonia, Spain.PatientsOne thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia.Main measurementsThe following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis.ConclusionsThe study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources.

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.

The objective is to identify the features associated with next year hospital admissions among elderly dependent patients living at home (EDLH) and visited by primary care teams at their home setting.Longitudinal cohort study of a sample of EDLH patients admitted to a home care programme delivered by 72 primary care teams. A global health assessment was performed at recruitment in all patients (health and social status, informal and formal carer characteristics and burden of care). We further collected data on visits by primary care personnel and the use of social, emergency and hospital services by EDLH patients throughout one year after recruitment.A sample of 1,093 EDLH patients was included. 258 (23,6%) patients were admitted to hospital during follow-up and 170 (15.6%) were lost to follow-up. Hospitalised patients received the same volume of primary care and social care services at home than those that were not hospitalised. Independent predictors of high risk of hospital admission were calling and using the after-hours emergency community services (odds ratio [OR]= 2.50, 95% confidence interval [95% CI] 1.56-4.01) and comorbidity as measured by the Charlson Index (OR= 1.16, 95% CI 1.06-1.27) at recruitment. Similarly, female sex (OR= 0.59, 95% CI 0.40-0.85) and high subjective physical health status scores as measured by the SF12 questionnaire (OR 0.97, 95% CI 0.95-0.99) predicted a low-risk of hospital admission.Hospital admission among EDLH patients is related to comorbidity, gender, subjective health status and the use of uncoordinated emergency services as measured at recruitment, rather than to the use of services during the one-year follow-up.

ResumenObjetivoidentificar las variables relacionadas con el hecho de recibir servicios sociales de carácter público o privado antes de la implantación de la Ley de Dependencia en pacientes recluidos en sus domicilios.Diseñoestudio descriptivo transversal.Emplazamiento72 equipos de atención primaria de Cataluña (EAP).Participantespacientes mayores de 64 años, no institucionalizados atendidos por un programa de atención domiciliaria de los EAP.Mediciones principalesde cada paciente se registraron: comorbilidad, estado funcional, estado cognitivo, si tenía úlceras por presión, salud subjetiva, valoración social, utilización de servicios sociales y sanitarios formales e informales, sobrecarga del cuidador, ingresos en residencias, hospitales o urgencias, además del número de visitas de profesionales santiarios.Resultadosparticipan 1.068 pacientes, el 46,8% recibe algún servicio social. Las variables relacionadas con la prestación de servicios sociales son: el grado de dependencia (Barthel), las úlceras por presión y recibir rehabilitación a domicilio. El test de Barthel está firmemente asociado a la problemática social (Gijón), carecer de cuidador informal, más de dos visitas de médico de familia y tener sanidad privada adicional.Conclusionespara ser más equitativa, la valoración de las prestaciones de la Ley de Dependencia debería considerar también el estado de salud. Antes de la aplicación de esta ley se intuye una dificultad de acceso a los servicios sociales formales para las clases medias que no acceden a las prestaciones públicas ni pueden pagarlas. Las prestaciones sociales son todavía una alternativa a la atención familiar.AbstractObjectiveTo identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law.DesignCross-sectional study.Setting72 primary health care teams in Catalonia.PatientsPatients over 64 years old with chronic diseases in home care programmes in Catalonia.MeasurementsHealth status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital.ResultsA total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care.ConclusionsTo be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care.

Objective: To identify the characteristics of chronic patients and their environment in order to predict the nursing workload required 1 year after their inclusion in a home care program. Methods: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain) with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected from each patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer, Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services, self-perceived health (SF-12) and the number of health worker visits. Results: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD 13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender (IRR = 1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR = 1.65, 95%CI: 1.29-2.13), decubitus ulcers (IRR = 4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR = 1.65, 95%CI: 1.31-2.07). In contrast, patients with major cognitive impairment (IRR = 0.78, 95%CI: 0.63-0.98) had a lower probability of receiving nursing visits at home. Conclusions: Workload can be predicted by patients’ clinical characteristics. The positive correlation of workload with variables related to disease severity and the negative correlation with variables related to cognitive impairment show that home care nursing in Catalonia is basically demand-oriented.