ABSTRACT
Fundamento y objetivo: Analizar la efectividad de una intervención educativa simple para mejorar el tratamiento de las comorbilidades cardiovasculares en los pacientes hospitalizados por una exacerbación de enfermedad pulmonar obstructiva crónica (EPOC). Material y métodos: Estudio multicéntrico con participación de 26 hospitales. Un grupo de expertos elaboró unas recomendaciones para el abordaje diagnóstico y terapéutico de la EPOC y las comorbilidades cardiovasculares (cardiopatía isquémica, fibrilación auricular, insuficiencia cardiaca y diabetes) que se graduaron como imprescindibles, aconsejables y sobresalientes. Se recogió el cumplimiento de las recomendaciones en los informes de alta de los pacientes ingresados en los servicios de Medicina Interna por reagudización de la EPOC. Se realizó una sesión clínica explicando los protocolos de atención a las comorbilidades en la EPOC y al cabo de 6 meses se volvió a observar el cumplimiento de dichas recomendaciones. Resultados: Se recogieron 390 casos antes y después de la intervención. Hubo mejoría significativa en el 53% de los ítems y esta mejoría fue mayor en los referidos al tratamiento general (66,7%) y al tratamiento de la EPOC (76,9%) y menor en los referidos a la cardiopatía isquémica (0,0%) y a la insuficiencia cardiaca (11,1%). Tras la intervención mejoró el cumplimiento de las recomendaciones en general (p=0,020) y de las imprescindibles (p=0,017), con una tendencia a la mejoría en las aconsejables (p=0,058) y las sobresalientes (p=0,063). Conclusiones: Una intervención simple puede mejorar la atención a los pacientes con exacerbación de EPOC, especialmente en el tratamiento de la enfermedad pulmonar, con pequeños cambios en el de las comorbilidades (AU)
Background and objective: To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Material and methods: Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months compliance with recommendations they were reassessed. Results: A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher (P=.020 and P=.017, respectively) and a trend to improve was observed in advisable (P=.058) and outstanding recommendations (P=.063). Conclusions: A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities (AU)
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/therapy , Cardiovascular Diseases/therapy , Evaluation of Results of Therapeutic Interventions , Comorbidity , Hospitalization/statistics & numerical data , Recurrence , Controlled Before-After Studies , Practice Patterns, Physicians'ABSTRACT
BACKGROUND AND OBJECTIVE: To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months' compliance with recommendations they were reassessed. RESULTS: A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher (P=.020 and P=.017, respectively) and a trend to improve was observed in advisable (P=.058) and outstanding recommendations (P=.063). CONCLUSIONS: A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities.
