La gestión del proceso de fibrilación auricular: un abordaje integral / Managing the atrial fibrillation process: An integral approach

Objetivos. El estudio se ha desarrollado en 3 fases cuyos respectivos objetivos han sido: definir el proceso de gestión más adecuado para la fibrilación auricular (FA) desde el punto de vista de profesionales y pacientes. Conocer cómo se gestiona en la práctica diaria. Identificar los cambios necesarios para que esta práctica diaria se aproxime a una gestión adecuada del proceso. Material y métodos. Diseño: 1.a fase: se han utilizado técnicas de consenso, un análisis de modos de fallo y sus efectos (AMFE) y un grupo focal con pacientes. 2.a fase: se ha desarrollado mediante encuesta. 3.a fase: se han realizado 3 grupos nominales y 3 grupos focales. Emplazamiento: Atención Primaria y Cardiología. Participantes: en la primera fase médicos de familia, cardiólogos y pacientes. En la segunda y tercera, médicos de familia. Mediciones principales: 1.a fase: se ha definido el diagrama de flujo, con sus notas explicativas, del proceso correcto de atención para la FA. 2.a fase: se ha investigado como se atiende en la práctica en la actualidad. 3.a fase: se han identificado las barreras para una correcta atención del proceso y se han definido propuestas para su mejora. Resultados. Casi el 40% de los médicos de familia se implicó en el diagnóstico y tratamiento de sus pacientes con FA. Se identificó la formación, la colaboración entre especialidades, motivación, trabajo en equipo con enfermería y cambios organizacionales como factores imprescindibles para una correcta gestión del proceso. Conclusiones. La FA puede ser gestionada desde Atención Primaria. Para ello son necesarios cambios relevantes en la organización de la asistencia. Se ven como imprescindibles tanto la formación como el apoyo y comunicación entre niveles(AU)

Objectives. The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. Material and methods. Design: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. Setting: Primary Care and Cardiology. Participants: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. Main measurements: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. Results. Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. Conclusions. AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary(AU)

[Managing the atrial fibrillation process: an integral approach]. / La gestión del proceso de fibrilación auricular: un abordaje integral.

OBJECTIVES: The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. DESIGN: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. SETTING: Primary Care and Cardiology. PARTICIPANTS: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. MAIN MEASUREMENTS: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. RESULTS: Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. CONCLUSIONS: AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary.