Search

ResumenObjetivoDeterminar la utilidad y viabilidad del Programa CRONIGICAT.DiseñoEstudio descriptivo transversal. Método de evaluación cualitativo y cuantitativoEmplazamiento y participantes26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona.Intervenciones20 proyectos dentro del programa. Inicio 2011Mediciones principalesGrado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad).ResultadosValoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado.ConclusionesRespecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual.AbstractObjectiveTo determine the utility and viability of a chronic care program.DesignCross-sectional descriptive study with qualitative and quantitative evaluation.Setting and participants26 primary care teams (PCT) from the Catalan health service of Gerona.Interventions20 projects within the program. Start 2011.Main outcome measuresThe degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]).ResultsEvaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care.ConclusionsWhen assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.

ResumenObjetivoEvaluar la efectividad de un programa de intervención multifactorial y comunitario para disminuir el número de caídas y sus complicaciones en la población de 70 años o más de una comunidad.DiseñoEstudio de intervención comunitaria, multicéntrico, con grupo control y sin asignación aleatorizada.EmplazamientoDos zonas básicas de salud de la provincia de Girona (España).ParticipantesMuestra aleatorizada de personas 70 años o más, 2.515 en el grupo de intervención (GI) y 1.212 en el grupo control (GC).El GI recibió una intervención multifactorial con actividades comunitarias, individuales en la consulta o domicilio y sobre los profesionales durante 2 años. El GC recibió la atención sanitaria habitual.Mediciones y resultados principalesSe valoró la situación basal de 2 muestras aleatorizadas representativas, GI (n=329) y GC (n=379), y la situación posintervención del GI (n=292) y el GC (n=310) mediante una encuesta.Personas con caídasGI basal, el 29% (intervalo de confianza [IC] del 95%: 25,8–31,9) y posintervención, el 31% (IC del 95%: 25,6–36,5); GC basal, el 32% (IC del 95%: 28,8–35,2) y posintervención, el 30% (IC del 95%: 24,9–35,4). Caídas con fracturas: GI basal, el 10,4% (IC del 95%: 6–16,3) y posintervención, el 5,3% (IC del 95%: 2–11,2); GC basal, el 7% (IC del 95%: 4–11,2) y posintervención, el 10,7% (IC del 95%: 5,8–17,7). Caídas con asistencia médica: GI basal, el 45,4% (IC del 95%: 37–54) y posintervención, el 43,8% (IC del 95%: 34,4–54,4); GC basal, el 30,3% (IC del 95%: 24,3–36,8) y posintervención, el 40,8% (IC del 95%: 31–51,2).ConclusionesUn programa de intervención comunitario multifactorial en personas de 70 años o más no reduce el número de caídas a los 2 años, pero se observa una tendencia a la reducción de sus consecuencias y puede integrarse dentro de la actividad asistencial habitual.AbstractObjectiveTo evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the ≥70 years population in a community.DesignMulticentre, community intervention study, with no random assignment and with controls.SettingTwo basic health areas in the province of Girona (Spain).ParticipantsRandom sample of people ≥70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG).The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care.Measurements and primary outcomesThe baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey.Results(People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2).ConclusionsA multifactorial community intervention programme in people ≥70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

Fundamento y objetivo Determinar la prevalencia de insuficiencia renal cronica (IRC) oculta y las variables clinicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y metodo Estudio observacional, analitico y transversal en pacientes con DM2 ambulatorios de atencion primaria. De la historia clinica electronica se registraron datos demograficos y antropometricos, antecedentes patologicos y medidas de riesgo cardiovascular y de funcion renal. Se determino la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmatica normales (Cr =1,4mg/dl en las mujeres y Cr =1,5mg/dl en los varones), y la estimacion del filtrado glomerular (eFG) reducida (

Introduction: The Programme for Prevention and Care of Chronic Illness in Girona CRONIGICAT aims to provide sustainable, integrated, quality care to chronic patients, targeted levels of care and interventions, and collaboration with other healthcare providers and social services. CRONIGICAT emerged during 2011 in the Girona Primary Care Region of the Institut Catala de la Salut as a result of the Health Plan 2011-2015 by the Department of Health of the Generalitat de Catalunya (Spain), which aimed to achieve a more chronic care oriented health care system. Short description of practice change implemented: CRONIGICAT includes a total of 20 different projects strategically related to the integration of care, continuity with social services, adapting the organization to the needs of chronic patients, patient involvement and self-care, prevention and health promotion, technological innovation, professional development and research. Aim and theory of change: To determine the usefulness and viability of a chronic care programme. CRONIGICAT has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116939 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 Targeted population: A population of approximately 500,000 people registered in 26 primary care teams (PCT). Stakeholders: 7 hospitals and 76 nursing homes Timeline: 2011-present Highlights: Design: Cross-sectional descriptive study with qualitative and quantitative evaluation. Main measures: The degree of development of the programme, consensus indicators for chronic care proposed by the policy maker, the Department of Health of the Generalitat de Catalunya, and the Assessment of Readiness for Chronicity in Health Care Organisations (ARCHO/IEMAC) tool. Outcomes: • Evaluation of the degree of development: 75% of projects were partially or fully implemented. • Improvement trends were found in the consensus indicators for process (e.g. patients contacted 48 hours after hospital discharge, population included in chronic care programmes). • Slight decline in the consensus indicators for effectiveness (e.g. readmissions, mean length of hospital stay, avoidable hospital admissions, medicines expenditure, number of emergency appointments, and mortality). • The dimensions receiving the highest scores on the ARCHO/IEMAC tool were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. Comments on sustainability: CRONIGICAT is sustainable in its implementation as all actions and projects are integrated within routine clinical practice. No additional resources are required for evaluation as the consensus indicators used are already compiled by the Department of Health. Comments on transferability: Implementation of projects directly focused on chronic patients carry a high degree of transferability of the actions designed. Conclusions: CRONIGICAT is useful, viable and sustainable. Discussions: Evaluation of a health care program can prove complex and it must take into account qualitative and quantitative aspects. Lessons learned: The need for integration within the health care system of the practical implementation of chronic care projects and their evaluation to allow the use of existing resources, and the involvement of all stakeholders towards common goals.

Objectives We investigated the relationship between leukocyte subtype counts and vascular structure and function based on carotid intima-media thickness, pulse wave velocity, central augmentation index and cardio-ankle vascular index by gender in intermediate cardiovascular risk patients. Methods This study analyzed 500 subjects who were included in the MARK study, aged 35 to 74 years (mean: 60.3 +/- 8.4), 45.6% women. Measurement: Brachial ankle Pulse Wave Velocity (ba-PWV) estimate by equation, Cardio-AnkleVascular Index (CAVI) using the VaSera device and Carotid ultrasound was used to measure carotid Intima Media Thickness (IMT). The Mobil-O-Graph was used to measure the Central Augmentation Index (CAIx). Results Total leukocyte, neutrophil and monocyte counts were positively correlated with IMT (p < 0.01) in men. Monocyte count was positively correlated with CAIx in women (p < 0.01). In a multiple linear regression analysis, the IMT mean maintained a positive association with the neutrophil count (beta = 1.500, p = 0.007) in men. CAIx maintained a positive association with the monocyte count (beta = 2.445, p = 0.022) in women. Conclusion The results of this study suggest that the relationship between subtype circulating leukocyte counts and vascular structure and function, although small, may be different by gender. In men, the neutrophil count was positively correlated with IMT and in women, the monocyte count with CAIx, in a large sample of intermediate-risk patients. These association were maintained after adjusting for age and other confounders., This work was supported by grants funded by the Spanish Ministry of Science and Innovation (MICINN) and Carlos III Health Institute/European Regional Development Fund (ERDF) (MICINN, ISCIII/FEDER) (Red RedIAPP RD06/0018, Research Groups: RD06/0018/2009, RD06/0018/0045/RD06/0018/0027) and by the Health Research Fund(FIS PI10/01088, PI10/02077, PI10/02043) and Regional Health Management of the Castilla and Leon(GRS 635/A/11). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL) has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment) without precluding the involvement of patients (real or simulated) in the design of assessment instruments

OBJECTIVE: To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the ≥70 years population in a community. DESIGN: Multicentre, community intervention study, with no random assignment and with controls. SETTING: Two basic health areas in the province of Girona (Spain). PARTICIPANTS: Random sample of people ≥70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. MEASUREMENTS AND PRIMARY OUTCOMES: The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. RESULTS: (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2). CONCLUSIONS: A multifactorial community intervention programme in people ≥70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

To improve quality of life, anxiety and depression in caregivers of patients in home care.We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made.The intervention group scored significantly better than the control group in relation to WONCA-feelings (p=0.03), WONCA-social activities (p=0.05), and WONCA-quality of life (p=0.02).A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life.