ABSTRACT
Objetivo: Describir las características de la gestión de casos en cuanto a población atendida, intervenciones, utilización de servicios y los desenlaces mortalidad, reingresos, úlceras por presión, caídas, problemas con medicamentos e institucionalización. Método: Estudio de seguimiento de una cohorte a partir del registro multicéntrico RANGECOM de Andalucía. La población de estudio son pacientes atendidos en la cartera de servicios de gestión de casos de centros de salud y sus cuidadores familiares. Resultados: Se presentan datos de 835 pacientes con edad media de 76,8años (DE:12,1), un 50,24% mujeres. Presentan una comorbilidad importante (Charlson 3,1; DE:2,5) y dependencia elevada (Barthel 37,5; DE:31,4). El 60,2% de las intervenciones desplegadas por las gestoras de casos se aglutina en tres dominios: conductual (26,0%), sistema sanitario (20,2%) y seguridad (14,1%). La mortalidad fue del 34,4% y los ingresos hospitalarios, del 38,1%. Los pacientes con más reingresos hospitalarios tenían más visitas a urgencias (OR:1,41; IC95%: 1,22-1,63), más intervenciones telefónicas de las gestoras de casos (OR:1,12; IC95%: 1,02-1,24) y pruebas de imagen (OR:1,37; IC95%: 1,17-1,60), junto con un mayor cansancio en la cuidadora (OR:1,31; IC95%: 1,08-1,59), la presencia de dispositivos médicos en domicilio (OR:1,69; IC95%: 1,00-2,87) y recibían menos la intervención «Gestión de Casos». Conclusiones: Los pacientes que absorben la demanda de las enfermeras gestoras de casos presentan una alta complejidad, frente a la cual despliegan intervenciones conductuales, de navegación por el sistema sanitario y de seguridad clínica
Objective: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Method: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Results: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. Conclusions: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Caregivers , Advanced Practice Nursing , Pressure Ulcer/nursing , Accidental Falls , Health Services Accessibility , Follow-Up Studies , Cohort Studies , Longitudinal StudiesABSTRACT
OBJECTIVE: To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. METHOD: Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. RESULTS: Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. CONCLUSIONS: The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.
Subject(s)
Case Management/organization & administration , Aged , Female , Follow-Up Studies , Humans , Male , Registries , SpainABSTRACT
OBJECTIVES: To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals. BACKGROUND: In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact. DESIGN: Systematic review. DATA SOURCES: Sixteen electronic databases were consulted (1990-2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies. REVIEW METHODS: Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease). RESULTS: Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients' and caregivers' satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers. CONCLUSION: Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.
Subject(s)
Advanced Practice Nursing , Geriatric Nursing , Aged , Humans , Long-Term CareABSTRACT
RATIONALE, AIMS AND OBJECTIVES: Case management is commonly used to provide health care for patients with multiple chronic conditions. However, the most effective form of team organization and the necessary support structures need to be identified. In this respect, patients' views could provide a valuable contribution to improving the design of these services. To analyse the experiences of patients with chronic diseases and of caregivers, in relation to health care services and mechanisms, and to identify means of modelling case management services. METHODS: The method used was a qualitative study based on life stories, and semi-structured interviews with 18 patients with complex chronic diseases and with their family caregivers, selected by purposeful sampling in primary health care centres in Andalusia (southern Spain) from 2009 to 2011. RESULTS: Three transition points were clearly identified: the onset and initial adaptation, the beginning of quality-of-life changes, and the final stage, in which the patients' lives are governed by the complexity of their condition. Health care providers have a low level of proactivity with respect to undertaking early measures for health promotion and self-care education. Care is fragmented into a multitude of providers and services, with treatments aimed at specific problems. CONCLUSIONS: Many potentially valuable interventions in case management, such as information provision, self-care education and coordination between services and providers, are still not provided.
Subject(s)
Case Management/organization & administration , Chronic Disease/psychology , Comorbidity , Patient Satisfaction , Aged , Female , Humans , Interviews as Topic , Male , Qualitative Research , Self CareABSTRACT
UNLABELLED: Pressure ulcers represent a major current health problem and produce an important economic impact on the healthcare system. Most of studies to prevent pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids and to date, no studies have specifically examined the use of olive oil-based substances. METHODS AND DESIGN: Main objective: To assess the effectiveness of the use of olive oil, comparing it with hyperoxygenated fatty acids, for immobilised home-care patients at risk of suffering pressure ulcers. Design: Non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Scope: Population attending Primary Healthcare Centres in Andalusia (Spain). Sample: 831 immobilised patients at risk of suffering pressure ulcers. RESULTS: The follow-up period was 16 weeks. Groups were similar after randomization. In the per protocol analysis, none of the body areas evaluated presented risk differences for pressure ulcers incidence that exceeded the 10% delta value established. Sacrum: Olive Oil 8 (2.55%) vs HOFA 8 (3.08%), ARR 0.53 (-2.2 to 3.26) Right heel: Olive Oil 4 (1.27%) vs HOFA 5 (1.92)%, ARR0.65 (-1.43 to 2.73). Left heel: Olive Oil 3 (0.96%) vs HOFA 3 (1.15%), ARR0.2 (-1.49 to 1.88). Right trochanter: Olive Oil 0 (0%) vs HOFA 4 (1.54%), ARR1.54 (0.04 to 3.03). Left trochanter: Olive Oil 1 (0.32%) vs HOFA 1 (0.38%), ARR0.07 (-0.91 to 1.04). In the intention to treat analysis the lower limit of the established confidence interval was never exceeded. DISCUSSION: The results obtained confirmed that the use of topical extra-virgin olive oil to prevent PU in the home environment, for immobilised patients at high risk, is not inferior to the use of HOFA. Further studies are needed to investigate the mechanism by which olive oil achieves this outcome. TRIAL REGISTRATION: Clinicaltrials.gov NCT01595347.
Subject(s)
Fatty Acids/therapeutic use , Immobilization/adverse effects , Olive Oil/therapeutic use , Pressure Ulcer/prevention & control , Aged , Aged, 80 and over , Caregivers , Female , Femur/pathology , Follow-Up Studies , Heel/pathology , Home Care Services , Humans , Male , Middle Aged , Patients , Pressure Ulcer/diagnosis , Pressure Ulcer/etiology , Primary Health Care , Sacrum/pathology , Treatment OutcomeABSTRACT
AIMS AND OBJECTIVES: To develop a questionnaire to address barriers and self-care behaviour among persons with type 2 diabetes mellitus. BACKGROUND: Several instruments are available in the literature to measure barriers to self-care in this population, but many of them present limitations in its psychometric validation process, and lack of theoretical background. DESIGN: Content validation study using multiple qualitative methods. METHODS: A systematic review was conducted, and two focus groups with fifteen participants (n = 15) were analysed to identify key topics and categories concerning barriers and self-care behaviour. These categories were used to generate items that were subjected to expert scrutiny, using the Delphi technique. The resulting list of items was tested for readability and comprehension by nine diabetic patients (n = 9), through cognitive interviews. The whole process was conducted in accordance with the Theory of Planned Behaviour. RESULTS: The mean age (standard deviation) of participants in the focus groups and cognitive interviews was 66·05 (8·47) and 63·11 (6·13) years, respectively. 46·7% of the members of the focus groups and 44·4% of those interviewed were female, and the mean duration (standard deviation) of their diabetes was 6·53 (3·17) and 4·89 (3·84) years, respectively. After the qualitative analysis, 27 codes were obtained. Thereafter, items were generated in accordance with the dimensions of this theory: attitudes towards the behaviour (n = 23), social norms (n = 13), perceived behavioural control (n = 17) and behavioural intention (n = 15). CONCLUSIONS: A rigorous process of content validation with multiple methods was implemented to obtain an instrument aimed at addressing barriers and self-care behaviour of patients with type 2 Diabetes Mellitus. RELEVANCE TO CLINICAL PRACTICE: An instrument theoretically rooted and supported on professional and patients' views is available to assess self-care behaviours in patients with type 2 Diabetes Mellitus. The evaluation of its reliability and construct validity will determine the instrument's value and practical application in the clinical context.
Subject(s)
Diabetes Mellitus, Type 2/psychology , Diabetes Mellitus, Type 2/therapy , Self Care/psychology , Aged , Delphi Technique , Female , Focus Groups , Health Behavior , Humans , Intention , Male , Middle Aged , Psychometrics , Reproducibility of Results , Social Norms , Surveys and QuestionnairesABSTRACT
AIM: To determine the psychometric properties and theoretical grounding of instruments that evaluate self-care behaviour or barriers in people with type 2 diabetes. BACKGROUND: There are many instruments designed to evaluate self-care behaviour or barriers in this population, but knowledge about their psychometric validation processes is lacking. DESIGN: Systematic review. DATA SOURCES: We conducted a search for psychometric or validation studies published between January 1990-December 2012. We carried out searches in Pubmed, CINAHL, PsycINFO, ProQuolid, BibliPRO and Google SCHOLAR to identify instruments that evaluated self-care behaviours or barriers to diabetes self-care. REVIEW METHODS: We conducted a systematic review with the following inclusion criteria: Psychometric or clinimetric validation studies that included patients with type 2 diabetes (exclusively or partially) and which analysed self-care behaviour or barriers to self-care and proxies like self-efficacy or empowerment, from a multidimensional approach. Language: Spanish or English. Two authors independently assessed the quality of the studies and extracted data using Terwee's proposed criteria: psychometrics properties, dimensionality, theoretical ground and population used for validation through each included instrument. RESULTS: Sixteen instruments achieved the inclusion criteria for the review. We detected important methodological flaws in many of the selected instruments. Only the Self-management Profile for Type 2 Diabetes and Problem Areas in Diabetes Scale met half of Terwee's quality criteria. CONCLUSION: There are no instruments for identifying self-care behaviours or barriers elaborated with a strong validation process. Further research should be carried out to provide patients, clinicians and researchers with valid and reliable instruments that are methodologically solid and theoretically grounded.
Subject(s)
Diabetes Mellitus, Type 2/nursing , Nursing Assessment/methods , Psychometrics/instrumentation , Self Care/instrumentation , Self Efficacy , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Patient Education as Topic , Psychometrics/methods , Self Care/methods , Validation Studies as TopicABSTRACT
BACKGROUND: Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. METHODS/DESIGN: The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student's t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. DISCUSSION: The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01595347.
Subject(s)
Fatty Acids/therapeutic use , Immobilization/adverse effects , Plant Oils/therapeutic use , Pressure Ulcer/prevention & control , Primary Health Care , Research Design , Clinical Protocols , Cost-Benefit Analysis , Drug Costs , Fatty Acids/economics , Humans , Logistic Models , Multivariate Analysis , Olive Oil , Plant Oils/economics , Pressure Ulcer/diagnosis , Pressure Ulcer/economics , Pressure Ulcer/etiology , Spain , Time Factors , Treatment OutcomeABSTRACT
AIMS: This protocol outlines a review and qualitative study to determine the models and effectiveness of Advanced Practice Nursing developed for the health care of people over 65 years in different settings (hospital care, home care, outpatients' care, and nursing homes) and to identify the ingredients of the interventions developed by Advanced Practice Nursing in the field of geriatric care. BACKGROUND: Numbers of nurses in advanced roles have increased internationally in conjunction with research to determine their effectiveness. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models, their components, and their impact. DESIGN: Study protocol with two phases: a systematic review and a qualitative study. METHODS: First phase: Depending on comparability of studies, meta-analysis will be undertaken. If so, results will be summarized in relative and absolute measures or mean difference, depending on the type of outcome. Sensitivity and heterogeneity analyses will be performed. Second phase: a content analysis will be carried out of the interventions identified in the systematic review, and they will be contrasted with the contents of the Nursing Interventions Classification. Finally, this matching will be submitted to expert consensus using a Delphi technique. Approval from the Ethics Committee was obtained in July 2010 and funding was obtained in March 2011. CONCLUSION: The identification of components of Advanced Practice Nursing models and evidence of their effectiveness will contribute to designing more grounded nursing services for older people. Additionally, the categorization of Advanced Practice Nursing interventions through Nursing Interventions Classification would permit comparisons to be made between settings or between healthcare systems.
Subject(s)
Advanced Practice Nursing , Geriatric Nursing , Nurse's Role , Nursing Evaluation Research , Research Design , Aged , Delphi Technique , Humans , Meta-Analysis as Topic , Qualitative Research , Systematic Reviews as TopicABSTRACT
BACKGROUND: The need of home care services is becoming an increasingly common scenario. These cares are mainly provided by the dependents' relatives specifically, by the women part of the family. This situation might take years, decreasing the physical and psychological health of the caregiver. In Spain, the Act of Promotion of Personal Autonomy and Care for dependent persons, guarantees those dependent persons and their caregivers to have access to social services or to financial grants. The aim of this study is to Know the possible effects of the benefits provided by this Act in regards to the mental health, the quality of life and use of health services by the family caregivers assisting their relatives in situation of dependency. METHODS AND DESIGN: A longitudinal descriptive study following-up a cohort of patients and caregivers. The study shall be carried out in Andalusia. It shall include the baseline assessment of the variables in those caregivers free from the exposure factor (reception of assistance pursuant to the Act). Following, once the benefits have been received, this cohort shall be followed-up.The study shall take three years, and the starting date for its development as well as its funding is January 2011. DISCUSSION: The longitudinal assessment of the rate of change of the variables studied shall allow us to know the implications which might be potentially generated as well as the natural evolution of those.
Subject(s)
Caregivers , Social Work/legislation & jurisprudence , Caregivers/psychology , Caregivers/statistics & numerical data , Health Services/statistics & numerical data , Home Care Services/legislation & jurisprudence , Humans , Income , Longitudinal Studies , Mental Health , Quality of Life/psychology , Social Class , Social Work/statistics & numerical data , Spain/epidemiologyABSTRACT
El debate sobre los recursos humanos en salud suele realizarse desde posicionesun tanto dogmáticas y, en general, con argumentos poco contrastadoscon resultados de investigación. Paradójicamente, son muchos los estudiosque en el campo de la provisión de cuidados evidencian que elincremento de enfermeras y su cualificación, intervienen sobre los resultadosasistenciales, como la reducción de la mortalidad o la estancia hospitalaria,entre otros.A lo largo de este artículo se exponen los resultados másrelevantes sobre la línea de investigación que en los últimos 20 años ha venidoasociando el número de enfermeras a los resultados de la atención hospitalaria,con especial énfasis en el último metaanálisis publicado al respecto,en el que se sientan los principios para determinar una relación causalde esta asociación. Finalmente, se realiza una discusión sobre las luces y sombrasde estos resultados, así como una contextualización de estos resultadoscon la realidad de nuestro medio en España (AU)
The debate on healthcare human resources can be carried out from differentperspectives that are somewhat dogmatic and generally based on argumentsthat have been limitedly contrasted with research results. Paradoxically,there are many studies in the field of healthcare delivery thatdemonstrate that an increase in nurses and their qualifications has an impacton healthcare outcomes, such as a decrease in mortality or length ofhospital stay, amongst others. In this article, the most relevant results derivedfrom the research line that in the last 20 years has associated thenumber of nurses with hospital healthcare outcomes are presented. Thelast published meta-analysis regarding this topic is emphasised given thatit is where the principles to determining a causal relationship of this associationare based. Finally, there is a discussion regarding the positivesand negative aspects of these results, as well as a contextualization of theseresults with the reality of our setting in Spain (AU)
Subject(s)
Humans , Public Health Nursing/statistics & numerical data , Health Personnel/trends , Nursing Care/trends , Personnel, Hospital/trends , Hospital Care , Quality of Health Care/trends , Hospital StatisticsABSTRACT
The evaluation of interventions in Public Health is a key element through the process of developing health policies, but it is not free of controversy. For doing this purpose it is essential the use of research outcomes, although there are sticking points related to the traditional approach of Evidence Based Medicine, dominated by the randomized clinical trial as the gold standard. Not always it is possible to develop randomized and controlled studies in Public Health (sometimes due to ethical limitations, or because of the technical impossibility for performing the trial or because conceptual incompatibility) and the interventions are mostly multifaceted, therefore, the interpretation of the results is a complex task. In other hand, the usual criteria for research appraisal underestimates systematically the observational studies which, frequently, are the indicated in Public Health scenarios. Nevertheless, a great advance has been implemented with the generation of strategies as TREND (Transparent Reporting of Evaluations with Non randomized Designs), as well as other instruments like STROBE (STrenghtening the Reporting of OBservational studies in Epidemiology) or MOOSE (Meta-analysis Of Observational Studies in Epidemiology). But regardless of the existence of more or less consolidated critical appraisal tools, we all need a solvent and rigorous way of knowing the outcomes of Public Health interventions. This would make more dynamic the review, design or planning phases, and it would contribute to facilitate the decision-making process when a well grounded knowledge be available. In this paper all the methodological process about searching evidence in Public Health interventions is reviewed, as well as the main sources providing this information, in order to facilitate this task to the Public health professionals.
Subject(s)
Community Health Services/organization & administration , Evidence-Based Medicine , Health Planning Guidelines , Public Health , Community Health Services/standards , Decision Making , Epidemiologic Studies , Humans , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Spain , Treatment OutcomeABSTRACT
La evaluación de intervenciones en Salud Pública constituye un pilar imprescindible en el desarrollo de políticas de salud, aunque no está exenta de controversias. Su desarrollo requiere la utilización de resultados de investigación, aunque hay grandes escollos derivados de un tradicional enfoque evaluativo basado en el ensayo clínico como patrón de oro, consolidado con el auge de la Medicina Basada en la Evidencia. En Salud Pública no siemprse pueden llevar a cabo diseños clásicos aleatorizados y controlados de forma estricta (a veces por criterios éticos, otras por razones operativas y otras por imposibilidad conceptual) y las intervenciones en la mayoría de ocasiones son de tipo multicomponente, lo que hace que la interpretación de resultados sea compleja. Por último, el enfoque habitual de evaluación de resultados de investigación infravalora sistemáticamente los estudios observacionales que, en muchos casos, son los indicados en Salud Públi-ca. Se ha dado un gran avance con estrategias como la TREND (Transparent Reporting of Evaluations with Non randomized Designs) junto con otros instrumentos de evaluación crítica, como el MOOSE (Meta-analysis Of Observational Studies in Epide-miology) o el STROBE (STrenghtening the Reporting of Obser-vational studies in Epidemiology). Independientemente de que existan o no modelos de evaluación consolidados, es necesaria una estrategia que con, cierta solvencia y rigor, permita conocer resultados de intervenciones en Salud Pública. Esto agiliza muchas veces las fases de revisión, diseño o planificación de la intervención concreta que se esté desplegando y ayuda a tomar decisiones en la medida en que se dispone de información contrastada. En este trabajo se revisa todo el proceso metodológico de localización de pruebas sobre la efectividad de intervenciones en Salud Pública, así como las fuentes más solventes disponibles en la actualidad, de cara a facilitar esta tarea a los profesionales dedicados o interesados en este campo (AU)
The evaluation of interventions in Public Health is a key element through the process of developing health policies, but it is not free of controversy. For doing this purpose it is essential the use of research outcomes, although there are sticking points related to the traditional approach of Evidence Based Medicine, dominated by the randomized clinical trial as the gold standard. Not always it is possible to develop randomized and controlled studies in Public Health (sometimes due to ethical limitations, or because of the technical impossibility for performing the trial or because conceptual incompatibility) and the interventions are mostly multifaceted, therefore, the interpretation of the results is a complex task. In other hand, the usual criteria for research appraisal underestimates systematically the observational studies which, frequently, are the indicated in Public Health scenarios. Nevertheless, a great advance has been implemented with the generation of strategies as TREND (Transparent Reporting of Evaluations with Non randomized Designs), as well as other instruments like STROBE (STrenghtening the Reporting of OBservational studies in Epidemiology) or MOOSE (Meta-analysis Of Observational Studies in Epidemiology). But regardless of the existence of more or less consolidated critical appraisal tools, we all need a solvent and rigorous way of knowing the outcomes of Public Health interventions. This would make more dynamic the review, design or planning phases, and it would contribute to facilitate the decision-making process when a well grounded knowledge be available. In this paper all the methodological process about searching evidence in Public Health interventions is reviewed, as well as the main sources providing this information, in order to facilitate this task to the Public health professionals (AU)
Subject(s)
Humans , Male , Female , Evidence-Based Medicine/education , Evidence-Based Medicine/methods , 50230 , Bibliometrics/history , Outcome and Process Assessment, Health Care/methods , Outcome and Process Assessment, Health Care/standards , Evidence-Based Medicine/organization & administration , Evidence-Based Medicine/standards , Delivery of Health Care/methods , EffectivenessABSTRACT
OBJECTIVES: To design and validate an instrument to assess satisfaction with home care services, in both self-administered and telephone versions. METHODS: We performed a cross-sectional observational study of the population using home care services in the health districts of Malaga, Costa del Sol, Almeria and Granada (Spain). A questionnaire was designed by an expert panel using a Deplhi technique. Reliability between the self-administered and telephone versions was analyzed. Finally, internal consistency and construct validity were assessed. RESULTS: Reliability between the self-administered and telephone versions was high (intraclass correlation coefficient = 0.876; 95% CI, 0.726-0.941; p = 0.0001). Internal consistency was adequate (Cronbach's alpha: 0.853 and 0.799 for both versions, with or without caregiver, respectively). The factorial analysis explained 66.80% and 67.81% of the observed variance for the two versions (with or without caregiver, respectively). Two factors were isolated and related to interpersonal relationships, the role of the carer, and decision making. CONCLUSION: Assessment of satisfaction with home care can be performed with the dimensions routinely used in satisfaction studies, but these should be evaluated with instruments designed ad hoc. Accessibility, communication and interpersonal relationships have a high explanatory value in satisfaction among this population.
Subject(s)
Home Care Services , Patient Satisfaction , Surveys and Questionnaires , Aged , Cross-Sectional Studies , Female , Humans , MaleABSTRACT
Objetivos: Construir y validar un instrumento que evalúe la satisfacción con los servicios de atención domiciliaria en versión autoadministrada y telefónica. Método: Estudio observacional transversal en población con atención domiciliaria de los distritos sanitarios de Málaga, Costa del Sol, Almería y Granada. Se diseñó un cuestionario por parte de expertos en la técnica Delphi. Posteriormente, se evaluó la fiabilidad entre las versiones telefónica y autoadministrada y, por último, se comprobó su validez de constructo y la consistencia interna. Resultados: La fiabilidad entre las versiones telefónica y autoadministrada fue alta (coeficiente de correlación intraclase = 0,876; intervalo de confianza del 95%, 0,726-0,941; p = 0,0001). La consistencia interna también fue adecuada (alfa de Cronbach de 0,853 y 0,799 para las distintas versiones, con o sin cuidadora, respectivamente). El análisis factorial explicaba un 66,80 y un 67,81% de la varianza observada para las distintas versiones (con o sin cuidadora). Se aislaron 2 factores que tenían que ver con la relación interpersonal, el rol de la cuidadora y la toma de decisiones. Conclusiones: La evaluación de la satisfacción con los servicios de atención domiciliaria puede realizarse con dimensiones habitualmente utilizadas en los estudios de satisfacción, aunque han de ser evaluadas mediante instrumentos diseñados al efecto. La accesibilidad, la comunicación y las relaciones interpersonales adquieren un alto valor explicativo en la satisfacción de este tipo de población
Objectives: To design and validate an instrument to assess satisfaction with home care services, in both self-administered and telephone versions. Methods: We performed a cross-sectional observational study of the population using home care services in the health districts of Malaga, Costa del Sol, Almeria and Granada (Spain). A questionnaire was designed by an expert panel using a Deplhi technique. Reliability between the self-administered and telephone versions was analyzed. Finally, internal consistency and construct validity were assessed. Results: Reliability between the self-administered and telephone versions was high (intraclass correlation coefficient = 0.876; 95% CI, 0.726-0.941; p = 0.0001). Internal consistency was adequate (Cronbach's alpha: 0.853 and 0.799 for both versions, with or without caregiver, respectively). The factorial analysis explained 66.80% and 67.81% of the observed variance for the two versions (with or without caregiver, respectively). Two factors were isolated and related to interpersonal relationships, the role of the carer, and decision making. Conclusion: Assessment of satisfaction with home care can be performed with the dimensions routinely used in satisfaction studies, but these should be evaluated with instruments designed ad hoc. Accessibility, communication and interpersonal relationships have a high explanatory value in satisfaction among this population
Subject(s)
Humans , Home Care Services/organization & administration , Patient Satisfaction/statistics & numerical data , Home Nursing/methods , Outcome and Process Assessment, Health Care/statistics & numerical data , Interpersonal Relations , Quality of Health CareABSTRACT
En la primera parte de este trabajo se expuso la situación actual de laoperativización de la producción científica enfermera, que justificaba lanecesidad de proponer un modelo de razonamiento que sirva de guíapara el proceso de toma de decisiones en la planificación de cuidados yque permita conjugar el modelo enfermero, las herramientas de lenguajey la evidencia científica.Se identificaron dos momentos clave en la toma de decisiones para llegaral juicio clínico enfermero: el juicio diagnóstico y el juicio terapéutico, yse apuntó el potencial beneficio de la utilización de la taxonomía deresultados (NOC) en este proceso. En esta segunda parte, se describe enprofundidad la utilidad de esta herramienta para todo el proceso enfermero,conjugando modelo, taxonomías y evidencia científica. Se muestranejemplos de posibles algoritmos para la toma de decisiones sobre eldiagnóstico y se argumenta sobre la posible utilidad del modelo propuestopara la validación de factores relacionados y características definitoriasde los diagnósticos, para la medición de resultados y para la elecciónmás apropiada de las intervenciones de tratamiento enfermero
The first part of this paper described the current operativisation of scientificnursing production that justified the need to propose a reasoningmodel to be used as a guide in the decision making process in the planningof care. Such model would permit to conjugate together the nursingmodel, language tools and scientific evidence.Two key moments were identified in the taking of decisions to reach aclinical nursing judgement: the diagnostic judgement and the therapeuticjudgement, addressing the potential benefit derived from the use oftaxonomy of NOC results in this process. This second part thoroughlydescribes the utility of this tool in the entire nursing process, conjugatingtogether model, taxonomies and scientific evidence. We presentexamples of possible algorithms for the making of decisions regardingdiagnosis, arguing about the possible utility of the model proposed forthe validation of related factors and the definitory characteristics of thediagnosis for the measurement of results and for the most appropriateselection of the interventions in the nursing treatment
Subject(s)
Humans , Nursing Diagnosis/trends , Terminology , Nursing Process/trends , Evidence-Based Medicine/trends , Decision MakingABSTRACT
Las consultas de enfermería para crónicos están consolidadas en la cartera de servicios de atención primaria por las coberturas alcanzadas y por la satisfacción de la población. Pero su contenido y los resultados que ofrecen pueden ser mejorados y la necesidad de reorientarlas viene siendo planteada desde hace tiempo. Las estrategias para conseguir el desarrollo de la contribución puramente enfermera a la salud de nuestros clientes, eso que llamamos dimensión independiente de la enfermería, pasa por la construcción de una visión enfermera de la que carecemos muchos de nosotros como consecuencia de una formación estructurada según el modelo biomédico y donde el paradigma enfermero se trasmitía más en lo teórico que en lo práctico. Usando a Doka y a Riopelle analizamos las fases que atraviesa un paciente afectado por una enfermedad física y las tareas que deben cumplimentar él y su familia, para encontrar una equivalencia entre éstas y algunos diagnósticos enfermeros de la North American Nursing Diagnosis Association (NANDA).Los diagnósticos enfermeros así obtenidos son comparados con los que un grupo de expertos, pertenecientes a la Comisión de Metodología del Distrito Sanitario Málaga, identificaron por consenso como los más prevalentes en esta población. El grado de coincidencias fue alto lo que nos anima a continuar con esta orientación en las consultas de enfermería para crónicos (AU)
