ABSTRACT
El desarrollo en la implantación del Programa de Autocontrol del paciente anticoagulado concluye con el seguimiento. Su objetivo es orientar, apoyar, asesorar y proporcionar al paciente el necesario soporte material y formativo mejorando así su autonomía y calidad de vida. Los contactos se establecen mediante llamadas telefónicas y visitas tanto programadas como no programadas. En el artículo se describe la teoría de esta fase intercalándola, para que sirva como ejemplo práctico, con la experiencia que ha supuesto en nuestra Unidad. Se relatan las cargas de trabajo de los distintos profesionales y los motivos de consulta más recurrentes. También se enumeran los contenidos que deben observarse en los contactos: problemas prácticos en la punción o en las tablas de dosificación, valoración del cumplimiento del programa, volcado de los datos registrados en el coagulómetro al sistema informático, revisión del autoanalizador, suministro del material y ajustes del tratamiento. Periódicamente se deben realizar revisiones de los registros que nos ayuden a detectar y evaluar los problemas que casi en su totalidad se resuelven con una educación sanitaria continua y permanente. Por último, presentamos un estudio realizado sobre la incidencia de los efectos adversos acaecidos en los pacientes autocontrolados que asistimos en nuestra Unidad(AU)
Development in the implementation of the programme of the anticoagulated patient self-management concludes with the follow-up. Your objective is to guide, support, advise and provide the patient with the necessary support material and training and improve their autonomy and quality of life. Contacts are established through both scheduled and unscheduled visits and phone calls. The article describes this phase interspersed, so serve as a practical example, with the experience which has resulted in our unit. Relates the workloads of different professionals and the most the recurrent causes of consultation. Also lists the contents that must be observed in the contacts: practical problems in the puncture or tables of dosing, assessment of the implementation of the programme, dump the data registered in the coagulometer to the computer system, revision of the autoanalyzer, material supply and treatment settings. Reviews of records that help us detect and assess problems that are resolved by a continuous and permanent health education almost in its entirety should periodically conduct. Finally, we present a study on the incidence of adverse effects occurring in self-controlled patients that we are witnessing in our unit(AU)
Subject(s)
Humans , Male , Female , Follow-Up Studies , Troleandomycin , Nursing Care/organization & administration , Nursing Care/trends , Nursing Care , Patient Care/methods , Nursing Care/classification , Nursing Care/methodsABSTRACT
Oral anticoagulant therapy (OAT) with Vitamin K antagonists requires frequent analytical controls that create a certain degree of dependency and a loss of autonomy in the patient. These drugs have an undesirable variability due to food and drug interactions, febrile processes, etc. which can modify the patient's INR and predispose them to a thromboembolic or hemorrhagic event. OAT self-control is supported by more than 15 years of experience in countries such as Germany and the Netherlands, and by comparative studies that reflect a reduction of thromboembolism and other adverse effects. The reason of this is because these patients are in the correct therapeutic range for longer periods of time due to more frequent controls (once a week against every 4-5 weeks of traditional control) and also to a better understanding of their treatment. In Aragon, OAT is a free health service and in our hospital, OAT has been an institutional aim since 2070. After a training course, the patient is capable to make their own INR determinations at home, to evaluate their results and adjust their own dose. Additionally the patient should acquire the appropriate knowledge to detect any adverse symptom and to know how to react to any problem in their treatment. This article summarizes our experience regarding the implementation of the programme and creation of the specific unit: the organization and training of the professionals involved, establishment of the patient selection criteria, and design of the patients' training course, follow-up strategy and equipment. In addition, the results of the study conducted in our Unit, showing a high degree of patient satisfaction, are included. At this moment 20% of our patients are included in the self-control strategy.
Subject(s)
Anticoagulants/administration & dosage , Patient Education as Topic , Administration, Oral , Humans , Program Development , Self AdministrationABSTRACT
El tratamiento anticoagulante oral (TAO) con antagonistas de la vitamina K requiere frecuentes controles analíticos que crean en el paciente un cierto grado de dependencia y pérdida de autonomía. Estos fármacos tienen un indeseable efecto variable debido a interacciones medicamentosas, alimentarias, comorbilidad, etc. que puede provocar una modificación de la INR (International Normalized Ratio) del rango terapéutico correcto y la posibilidad de sufrir algún evento tromboembólico o hemorrágico. El programa de autocontrol del TAO está avalado por una experiencia superior a 15 años en países como Alemania y Holanda, y por numerosos estudios en los que queda reflejada una reducción de los efectos adversos, principalmente de carácter tromboembólico. Esto es debido a que los pacientes se encuentran más tiempo en el rango terapéutico correcto, al ser más frecuentes los controles analíticos y ajustes de dosis (una vez a la semana frente a las 4-5 semanas del control tradicional) y a un mejor conocimiento de su tratamiento. En la CCAA de Aragón esta prestación sanitaria gratuita y en nuestro hospital es un objetivo institucional desde el año 2010. El programa consiste en capacitar al paciente para realizarse la determinación de la INR en su autoanalizador, interpretar el resultado y ajustar su propia dosis acomodándola a los cambios sufridos. Así mismo, debe adquirir los conocimientos adecuados para advertir cualquier síntoma adverso y saber reaccionar ante cualquier problema en su tratamiento. En este artículo relatamos nuestra experiencia en la creación de la unidad y la implantación del programa: estructuración y formación de los profesionales implicados, elección de los criterios en la selección de los pacientes, material necesario, diseño del curso de aprendizaje de los pacientes, estrategia de la evolución y seguimiento. Además se incluyen los resultados de un estudio realizado en nuestra unidad, donde se muestra el alto grado de satisfacción de los pacientes adscritos. Se ha logrado implantar el programa con una gran aceptación. Actualmente se halla incluido el 20% del total de asistidos(AU)
Oral anticoagulant therapy (OAT) with Vitamin K antagonists requires frequent analytical controls that create a certain degree of dependency and a loss of autonomy in the patient. These drugs have an undesirable variability due to food and drug interactions, febrile processes, etc. which can modify the patient's INR and predispose them to a thromboembolic or hemorrhagic event. OAT self-control is supported by more than 15 years of experience in countries such as Germany and the Netherlands, and by comparative studies that reflect a reduction of thromboembolism and other adverse effects. The reason of this is because these patients are in the correct therapeutic range for longer periods of time due to more frequent controls (once a week against every 4-5 weeks of traditional control) and also to a better understanding of their treatment. In Aragon, OAT is a free health service and in our hospital, OAT has been an institutional aim since 2010. After a training course, the patient is capable to make their own INR determinations at home, to evaluate their results and adjust their own dose. Additionally, the patient should acquire the appropriate knowledge to detect any adverse symptom and to know how to react to any problem in their treatment. This article summarizes our experience regarding the implementation of the programme and creation of the specific Unit: the organization and training of the professionals involved, establishment of the patient selection criteria, and design of the patients' training course, follow-up strategy and equipment. In addition, the results of the study conducted in our Unit, showing a high degree of patient satisfaction, are included. At this moment 20% of our patients are included in the self-control strategy (AU)
