Implementación de las Unidades Docentes Multiprofesionales de Atención Familiar y Comunitaria en Cataluña / Implementation of Multiprofessional Teaching Units of Family and Community Care in Catalonia

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[A MODEL OF COMPREHENSIVE CARE FOR COMPLEX CHRONIC PATIENT. EXPERIENCE OF A TERRITORY]. / Un modelo de atención integral al paciente crónico complejo. EXPERIENCIA DE UN TERRITORIO.

INTRODUCTION: The Increase in life expectancy has brought an increase in chronic diseases. The evolution of chronic disease is the cause of several organic and systemic dysfunctions, leading to physical and mental limitations that determine the need for some aid to perform basic vital tasks. Primary health care has a key role in the monitoring of fragility, chronicity, and complexity of population. However, in order to address properly high complexity diseases it is necessary to know and coordinate the different resources existing inside the territory. THE DEVELOPMENT OF THE MODEL FOR ACTION: THE IMPLEMENTATIONS OF A FUNCTIONAL UNIT. The Primary Health Care must ensure equity, accessibility, longitudinally, and continuity of care, bearing in mind that health outcomes must be optimal. There are several health care providers in the Delta del Llobregat SAP, so it was implemented a strategic plan focused on the coordination and/or the reconciliation of all the devices involved in the assistance in order to provide comprehensive attention to the patient. The patients included in this program were to be identified as CCP (Complex chronic Patient), in an evolved and tributary phase of intensive follow-up. CONCLUSIONS. The identification ofpatients listed as CCP and at clinical risk allows a comprehensive monitoring in order to prevent exacerbations and overuse of unscheduled hospital resources.

A Program of Nurse Management for Unscheduled Consultations of Children With Acute Minor Illnesses in Primary Care.

INTRODUCTION: Attention to patients with acute minor illnesses represents a major burden for primary care. Although programs of nurse care for children with acute minor illnesses in primary care started a long time ago, there is limited information about the results of these programs in current practice. OBJECTIVES: The objective of this study was to assess the feasibility and efficacy of a program of nurse management for unscheduled consultations of children with acute minor illnesses. METHODS: Observational study of children seeking unscheduled consultations for 16 acute minor illnesses in 284 primary care practices during a 2-year period. The program of nurse management used predefined management algorithms. FINDINGS: Among 467,160 consultations performed, case resolution was achieved in 65.4%. The remaining 34.6% of cases were not solved by the primary healthcare nurse due to the existence of signs of alarm and were referred to a pediatrician. Return to consultation during a 7-day period for the same reason as the original consultation was only 2.6%. CONCLUSIONS: A program that uses management algorithms is effective for nurse care management of children with acute minor illnesses in primary care. CLINICAL RELEVANCE: Application of programs of nurse management for unscheduled consultations for children with acute minor illnesses is feasible and effective.

Un modelo de atención integral al paciente crónico complejo. Experiencia de un territorio / A model of comprehensive care for complex chronic patient. Experience of a territory

Introducción. El aumento de la esperanza de vida ha comportado un incremento de patologías crónicas. La evolución de las enfermedades crónicas es causa de disfunciones orgánicas y sistémicas, las cuales causan limitaciones físicas y psí- quicas que obligan a establecer ayudas para poder realizar las tareas vitales básicas. La Atención Primaria (AP) tiene un papel clave en el seguimiento de la fragilidad, cronicidad y complejidad de la población, pero para atender la alta complejidad de forma adecuada es preciso conocer y coordinar los distintos recursos existentes en el territorio. Desarrollo del modelo de actuación: creación de una unidad funcional. La AP debe garantizar la equidad, la accesibilidad, la longitudinalidad y la continuidad asistencial, sin olvidar que los resultados en salud deben ser óptimos. En el SAP Delta del Llobregat existen varios proveedores de la salud, por lo que se elaboró un plan estratégico centrado en la coordinación i/o conciliación de todos los dispositivos implicados en la asistencia para dar una atención integral a la persona. Los pacientes incluidos en este programa debían estar identificados como PCC, en fase evolucionada y tributaria de seguimiento intensivo. Conclusiones. La identificación de las persones catalogadas como PCC y en situación de riesgo clínico permite un seguimiento exhaustivo a fin de evitar exacerbaciones y la hiperutilización de los recursos hospitalarios no programados (AU)

Introduction. The Increase in life expectancy has brought an increase in chronic diseases. The evolution of chronic disease is the cause of several organic and systemic dysfunctions, leading to physical and mental limitations that determine the need for some aid to perform basic vital tasks. Primary health care has a key role in the monitoring of fragility, chronicity, and complexity of population. However, in order to address properly high complexity diseases it is necessary to know and coordinate the different resources existing inside the territory. The development of the model for action: the implementations of a functional unit. The Primary Health Care must ensure equity, accessibility, longitudinally, and continuity of care, bearing in mind that health outcomes must be optimal. There are several health care providers in the Delta del Llobregat SAP, so it was implemented a strategic plan focused on the coordination and/or the reconciliation of all the devices involved in the assistance in order to provide comprehensive attention to the patient. The patients included in this program were to be identified as CCP (Complex chronic Patient), in an evolved and tributary phase of intensive follow-up. Conclusions. The identification of patients listed as CCP and at clinical risk allows a comprehensive monitoring in order to prevent exacerbations and overuse of unscheduled hospital resources (AU)

Comparación nutricional de purés infantiles caseros verus industriales / Comparison of nutritional contents between homemade and industrial baby food

Introducción. Los cambios sociales y familiares provocan variacionesen los hábitos alimentarios de los lactantes, con un aumentodel consumo de purés comerciales. Desde nuestro servicio depediatría de atención primaria se planteó si estos productos aportabanuna nutrición adecuada para los niños.Objetivos. El objetivo de nuestro trabajo fue analizar las diferenciasentre el contenido nutricional de los purés infantiles caseros ylos preparados industriales.Material y método. Se elaboraron tres purés estándar caseros (verduracon ternera, fruta y verdura con pescado) y se realizó un análisisnutricional de estos (aporte calórico-energético, carbohidratos,proteínas y lípidos) utilizando las tablas Sandoz y Cesnid. Elsegundo punto fue el análisis nutricional de purés comerciales,según etiquetaje, de tres marcas, con nutrientes similares a los preparadoscaseros. En un tercer punto se realizó la comparación deambos. Una nutricionista diplomada realizó el asesoramiento sobreel estudio.Resultados. Una vez analizados todos los productos se obtuvieronlos siguientes resultados: las preparaciones de verduras con carneo pescado de los potitos industriales presentaban un contenidoenergético inferior, hasta un 40%, en comparación con las preparacionescaseras. En cuanto al contenido lipídico, éste es superior(hasta el 50%) en las preparaciones caseras, pero el porcentaje degrasas saturadas (aterógenas) es muy superior (entre 50-60%) enlos preparados industriales.Las preparaciones de frutas industriales tienen un contenido energéticosuperior (35%). El contenido total de carbohidratos es eldoble que en los preparados caseros. En cuanto al contenido lipídicoy proteico, no se encontraron diferencias.Conclusiones. Los niños alimentados habitualmente con potitosindustriales reciben un aporte de carbohidratos inferior al recomendado,con un exceso de carbohidratos simples...(AU)

Introduction. Social and familial changes lead to alterations inthe feeding habits of infants, with an increase in the use ofcommercial baby foods. Our primary pediatric care unit soughtout to investigate whether those products were able to provideadequate nutrition.Objective. To analyze the differences in nutritional content betweenhomemade and commercial baby food.Method. Three standard homemade purées (beef and vegetables,fruits, and fish and vegetables) were made, and a nutritionalanalysis (caloric and energetic content, carbohydrates, lipids, andproteins) was performed using the Sandoz and Cesnid tables. Wethen analyzed the nutritional content of three equivalent commercialand compared the results of both groups.Results. The energetic content of commercial products of vegetableswith beef or fish was up to 40% inferior to the homemadepurees. The lipid content was higher (up to 50%) in the homemadefood, but the percentage of saturated (aterogenic) fat washigher (50-60%) in the commercial purees. The energetic contentof commercial fruit purees was 35% higher. Likewise, the totalcarbohydrate content was twice than in the homemade products,whereas there were no differences in the lipid and proteincontents.Conclusions. Children fed with commercial baby food receive loweramounts of carbohydrates than recommended, with an excessof simple carbohydrates. Commercial vegetable purees provide alower caloric content. In a complete menu using commercial products,the caloric intake is inverted: more energy is delivered withthe desert than with the main course. Even though the overall lipidintake is lower with commercial products, the aterogenic loadis higher(AU)