Influencia de las enfermeras gestoras de casos en la calidad de vida de las cuidadoras de pacientes pluripatológicos / Influence of nurses case managers in the quality of life of caregivers of patients with complex chronic diseases

Objetivo: determinar el efecto a medio plazo de las enfermeras gestoras de casos hospitalarias sobre la sobre la calidad de vida de las cuidadoras. Método: se realizó un estudio observacional, analítico de tipo cohortes, (gestoras frente a control), entre los pacientes pluripatológicos ingresados en el Complejo Hospitalario de Jaén. La calidad de vida se midió mediante el cuestionario SF-36 durante el ingreso y tras 90 días del alta. Se realizó también el cálculo de las puntuaciones sumario que permite el cuestionario: componente sumario física (CSF) y mental (CSM), mediante la combinación de las puntuaciones de cada dimensión, presentándose como puntuaciones basadas en la normalidad de la población española. Resultados: la puntuación del SF-36 es superior en la cohorte de control en todas las dimensiones durante todo el estudio. La dimensión del rol físico cuando el paciente está ingresado es la que peor puntuación tiene, aunque mejora notablemente tras el alta. La CSF y CSM de las cuidadoras está por debajo de la media española tanto durante el ingreso como a los 90 días del alta. La CSF del grupo gestoras mejora al alta, mientras que empeora en el grupo control. Al contrario ocurre con la CSM, que empeora en el grupo gestoras y mejora en el control. Conclusiones: las cuidadoras de pacientes pluripatológicos presentan una importante afectación en el rol físico al ingreso, que mejora notablemente a los 90 días del alta. La CSF y CSM están por debajo de la media española

Aims: To determine the medium-term impact of Hospital Nurses Case Managers on the quality of life of carers. Methods: An observational study cohort type (case-nurse managers vs. control), among patients with complex chronic disease admitted to the Jaén University Hospital. Quality of life was measured by the SF-36 at admission and after 90 days of discharge. Also performed the calculation of summary scores that allows the questionnaire: physical component summary (PCS) and mental (MCS), by combining the scores for each dimension, appearing as normal scores based on Spanish population. Results: The score of the SF-36 is higher in the control group in all dimensions throughout the study. The dimension of the physical role when the patient is admitted is the worst score has improved significantly after discharge. The PCS and MCS is below the Spanish average both during admission and 90 days after discharge. The case-nurse managing group PCS improves to discharge, while worsening in the control group. Unlike the case with MCS worsening in group case-nurse and improving in the control. Conclusions: The caregivers of patients with multiple comorbidities have a significant affectation in the admission physical role, dramatically improving after 90 days of discharge. The CSF and CSM are below the Spanish average

Effect of hospital case-manager nurses on the level of dependence, satisfaction and caregiver burden in patients with complex chronic disease.

AIMS AND OBJECTIVES: To determine the medium-term effects of nurse case management on the dependence and satisfaction of patients with complex chronic disease and on caregiver burden. BACKGROUND: Caregiver exhaustion increases the readmission rate of highly dependent patients with complex chronic disease and their consumption of primary care resources. DESIGN: An observational and analytical cohort study was undertaken in multimorbid patients. METHODS: Data were gathered on Barthel Index and Caregiver Burden Index scores, primary care resource consumption, readmission and mortality rates, and patient satisfaction with care and care continuity. Results were compared between nurse case-managed (n = 62) and control (n = 193) multimorbid patients using univariate and bivariate analyses. RESULTS: The study included 255 patients with complex chronic disease (24·32% in management cohort vs. 75·68% in control cohort). The nurse case-managed group had significantly lower Barthel Index and higher Caregiver Burden Index scores and a significantly longer hospital stay. At 90 days postdischarge, no significant intergroup differences were observed in Barthel Index or Caregiver Burden Index scores, primary care resource consumption, readmission rate or mortality rate; the case-managed patients showed a significantly higher satisfaction level with their care and its continuity. CONCLUSIONS: Nurse case management prevents a postdischarge increase in the dependence of multimorbid patients and the burden of their caregivers. RELEVANCE TO CLINICAL PRACTICE: Application of nurse case management can reduce the readmission rate and primary care consumption of patients with chronic complex disease after their hospital stay and prevent an exacerbation of caregiver exhaustion.