Innovative Health and Social Integrated Care Model Effectiveness to Improve Quality Care for Chronic Patients: A Single Group Assignment Clinical Trial.

Background: Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes. Methods: The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients' quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention. Results: The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention. Conclusions: Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.

The costs associated with stroke care continuum: a systematic review.

Stroke, a leading cause of death and long-term disability, has a considerable social and economic impact. It is imperative to investigate stroke-related costs. The main goal was to conduct a systematic literature review on the described costs associated with stroke care continuum to better understand the evolution of the economic burden and logistic challenges. This research used a systematic review method. We performed a search in PubMed/MEDLINE, ClinicalTrial.gov, Cochrane Reviews, and Google Scholar confined to publications from January 2012 to December 2021. Prices were adjusted using consumer price indices of the countries in the studies in the years the costs were incurred to 2021 Euros using the World Bank and purchasing power parity exchange rate in 2020 from the Organization for Economic Co-operation and Development with the XE Currency Data API. The inclusion criteria were all types of publications, including prospective cost studies, retrospective cost studies, database analyses, mathematical models, surveys, and cost-of-illness (COI) studies. Were excluded studies that (a) were not about stroke, (b) were editorials and commentaries, (c) were irrelevant after screening the title and abstract,(d) grey literature and non-academic studies, (e) reported cost indicators outside the scope of the review, (f) economic evaluations (i.e., cost-effectiveness or cost-benefit analyses); and (g) studies not meeting the population inclusion criteria. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 724 potential abstracts were identified of which 25 articles were pulled for further investigation. The articles were classified into the following categories: 1)stroke primary prevention, 2) expenditures related to acute stroke care, 3) expenditures for post-acute strokes, and 4) global average stroke cost. The measured expenditures varied considerably among these studies with a global average cost from €610-€220,822.45. Given the great variability in the costs in different studies, we can conclude that we need to define a common system for assessing the costs of strokes. Possible limitations are related to clinical choices exposed to decision rules that trigger decisions alerts within stroke events in a clinical setting. This flowchart is based on the guidelines for acute ischemic stroke treatment but may not be applicable to all institutions.

Integrated Care Model Salut+Social Assessment by Professionals, Informal Caregivers and Chronic or Social Dependent Patients: A Qualitative Study.

We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals' perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users' assessment of the care received within the program framework; (6) users' perception of the impact on health and wellbeing; (7) users' demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users' satisfaction with the care received.

Efectividad de un programa comunitario de apoyo a cuidadores de pacientes con demencia: escuela del cuidar / Effectiveness of a community support program for caregivers of patients with dementia: school of care

Objetivo: conocer las necesidades que expresan los cuidadores de pacientes con demencia en relación a aspectos formativos, de apoyo psicosocial, resolución de problemas y entrenamiento de habilidades. Diseñar, implementar y evaluar un programa comunitario de apoyo a cuidadores de pacientes con demencia que mejore su calidad de vida como cuidador y su experiencia de cuidar. Método: estudio de metodología mixta según la guía de la Medical Research Council sobre evaluación de intervenciones complejas, en tres fases. Fase 1: Modelización y operativización de la intervención (cualitativo). Fase 2: Estudio cuasi-experimental pre/post-intervención con medidas repetidas antes y después de la intervención y a los seis meses. Fase 3: Evaluación del programa de intervención (cualitativo).La población objeto de estudio son los cuidadores de pacientes no institucionalizados con diagnóstico de demencia, con grado de dependencia 1, 2 o pendientes de grado de las comarcas del Montsiá y Baix Ebre (Tarragona, España) en el ámbito de Atención Primaria, para el periodo 2020-2022. Conclusiones: realizar un estudio de metodología mixta desde la Atención Primaria y con colaboración ciudadana permitirá el diseño de una intervención adaptada la realidad de los sujetos de estudio. Su aplicación podría ser relevante ya que, si se confirman los objetivos propuestos, este estudio establecería una base para modificar el abordaje a los cuidadores y el apoyo que deben recibir, iniciándose desde el momento del diagnóstico del paciente, minimizando la sobrecarga del cuidador, mejorando su calidad de vida y su apoyo social.(AU)

Objectives: to understand the needs expressed by caregivers of patients with dementia regarding aspects of training, psychosocial support, solution of problems and training in skills. To design, implement and evaluate a community support program for caregivers of patients with dementia, which will improve their quality of life as caregivers and their caring experience. Method: a mixed methodology study according to the Medical Research Council guidelines on evaluation of complex interventions, in three stages. Stage 1: Modelling and implementation of the intervention (qualitative). Stage 2: Quasi-experimental pre-post intervention study with measurements repeated before and after the intervention and at six months. Stage 3: Evaluation of the intervention program (qualitative).The population object of the study are caregivers of non-institutionalized patients with diagnosis of dementia, with degree of dependence 1 or 2 or pending degree, in the Montsiá and Baix Ebre regions (Tarragona, Spain) in the Primary Care setting, for the 2020-2022 period. Conclusions: to conduct a mixed methodology study from Primary Care and with collaboration by citizens will allow to design an intervention adapted to the reality of the study subjects. Its application could be relevant, because if the objectives are confirmed, this study would establish the basis for modifying the way to address caregivers and the support they must receive, by being initiated since patient diagnosis, reducing caregiver overload to a minimum, and improving their quality of life and social support.(AU)

Effectiveness of the integrated care model Salut+Social in patients with chronic conditions: A mixed methods study protocol.

INTRODUCTION: Integrated care models aim to provide solutions to fragmentation of care by improving coordination. This study will evaluate the effectiveness of a new integrated care model (Salut + Social), which will promote the coordination and communication between social and healthcare services in southern Catalonia (Spain) to improve quality of life, adherence to treatment and access to medical services for patients with chronic conditions, and also to reduce caregiver burden. Additionally, we will evaluate the experience of caregivers, health professionals and social workers with the new model implemented. METHODS AND ANALYSIS: A clinical trial using mixed methodology will be carried out. The intervention consists of improving the coordination between the social and healthcare sectors during a 6-month period, by means of information and communication technology (ICT) tools that operate as an interface for the integrated care model. The study subjects are primary care patients with chronic health and social conditions that can benefit from a collaborative and coordinated approach. A sample size of 141 patients was estimated. Questionnaires that assess quality of life, treatment adherence, medical service and caregiver burden will be used at baseline and at 6, 9, and 12 months after the beginning of the study. The principal variable is quality of life. For statistical analysis, comparisons of means and proportions at different time points will be performed. A discussion group and semi-structured interviews will be conducted with the aim of improving the care model taking into account the opinions of professionals and caregivers. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P17/100). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04164160.