Training primary care professionals in multimorbidity management: Educational assessment of the eMULTIPAP course.

Multimorbidity (MM) is a widespread problem and it poses unsolved issues like the healthcare professionals' training. A training curriculum has been proposed, but it has not been sufficiently explored in a clinical context. The eMULTIPAP course is part of the MULTIPAP complex intervention, applied through a pragmatic controlled, cluster randomized clinical trial to general practitioners (GP) and his/her patients with MM with 12 months follow-up. The eMULTIPAP course is based on problem-based learning, constructivism and Ariadne principles. It has been assessed according to the Kirkpatrick model and has shown knowledge improvement and high applicability of learning with more motivation to consider MM in the clinical practice. It has also improved the Medication Appropriateness Index at 6-months and at 12- months. We conclude that the eMULTIPAP course generates significant changes in GP's learning, enhancing clinical practice in multimorbidity scenarios.

Análisis de una intervención para la mejora de resultados en salud en EPOC agudizada en atención primaria / Analysis of an intervention to improve health outcomes in acute exacerbations of COPD in primary care

OBJETIVO: Analizar la efectividad de una intervención en profesionales sanitarios de atención primaria (AP) en la mejora de resultados de salud de pacientes agudizadores de EPOC (AEPOC). DISEÑO: Observacional, con análisis retrospectivo y prospectivo. Emplazamiento. Distrito Sanitario Málaga-Guadalhorce (DSMG). PARTICIPANTES: Pacientes EPOC agudizados atendidos por los dispositivos móviles de urgencias del DSMG (n = 523; 21% pérdidas). INTERVENCIONES: Formación a los profesionales en la práctica clínica habitual e inclusión de indicadores de proceso de EPOC en objetivos ligado a incentivos. Mediciones principales. Comparación de variables de proceso y de resultado mediante auditoría de la historia clínica. Variable respuesta: diferencia de agudizaciones en 2 periodos analizados. Análisis bivariante y multivariante. RESULTADOS: Edad media 75 (±9,3) años; varones 63,7%, con un IMC de 29,4 (± 7,1); fumadores activos 21%. El FEV1 medio fue del 48,2% (± 18,7). La media de agudizaciones en el primer período fue de 2,86 (± 2,29) y en el segundo, de 1,36 (± 1,56) (p < 0,001). La media de ingresos en el primer y segundo periodos fue 0,56 (± 0,94) y 0,31 (± 0,66) (p < 0,001), respectivamente. La disminución del número de agudizaciones se relacionó de forma directa con haber tenido ≥2 agudizaciones en el primer período, exacerbación revisada en atención primaria y de forma inversa con tener insuficiencia cardiaca y ≥ 2 agudizaciones en el segundo período (coeficiente de determinación R2 = 0,28; p < 0,001). CONCLUSIONES: El número de agudizaciones y de ingresos entre ambos periodos evaluados disminuyó significativamente. Sin embargo, no mejoraron los indicadores de proceso evaluados. Se precisan estudios prospectivos de intervención para establecer la posible relación causal

OBJECTIVE: To examine the impact of an intervention by Primary Care (PC) professionals of a Health District on the clinical outcomes for treating COPD exacerbations using a process and outcome indicators analysis (clinical audit). DESIGN: Observational, retrospective and prospective analysis cross-sectional audit of clinical practice. SETTING: Malaga-Guadalhorce Sanitary District (DSMG). Participants. Patients with COPD exacerbations treated by the extra-hospital emergency services (n = 523; 21% losses). INTERVENTIONS: Professional training in the usual clinical practice and inclusion of process indicators of COPD targets in relation to incentives. Principal measurements. Comparison of external audit results (process and outcomes variables) from medical records and Health Outcomes (exacerbations, admissions). Variable response: Difference in exacerbations and admissions in 2 periods analysed. Bivariate and multivariate analysis. RESULTS: Mean age was 75 (± 9.3), 63.7% males with a BMI of 29.4 (±7.1), and 21% active smokers. Mean FEV1, 48.2% (± 18.7). Mean exacerbations in the first period, 2.86 (± 2.29) and in the second 1.36 (± 1.56) (P <. 001). Mean hospital admissions in the first and second period, 0.56 (±0.94) and 0.31 (± 0.66) (P < .001), respectively. The decrease in the number of exacerbations was directly associated with having ≥ 2 exacerbations in the first period, reviewed in Primary Care, and inversely with heart failure and with having ≥ 2 exacerbations in the second period (R2 = 0.28; P < .001). CONCLUSIONS: The number of exacerbations and admissions decreased significantly in both periods assessed. However, the evaluated process indicators did not improve. Prospective intervention studies are necessary to establish the possible causal relationshi

[Analysis of an intervention to improve health outcomes in acute exacerbations of COPD in primary care]. / Análisis de una intervención para la mejora de resultados en salud en EPOC agudizada en atención primaria.

OBJECTIVE: To examine the impact of an intervention by Primary Care (PC) professionals of a Health District on the clinical outcomes for treating COPD exacerbations using a process and outcome indicators analysis (clinical audit). DESIGN: Observational, retrospective and prospective analysis cross-sectional audit of clinical practice SETTING: Malaga-Guadalhorce Sanitary District (DSMG). PARTICIPANTS: Patients with COPD exacerbations treated by the extra-hospital emergency services (n=523; 21% losses). INTERVENTIONS: Professional training in the usual clinical practice and inclusion of process indicators of COPD targets in relation to incentives. PRINCIPAL MEASUREMENTS: Comparison of external audit results (process and outcomes variables) from medical records and Health Outcomes (exacerbations, admissions). Variable response: Difference in exacerbations and admissions in 2 periods analysed. Bivariate and multivariate analysis. RESULTS: Mean age was 75 (±9.3), 63.7% males with a BMI of 29.4 (±7.1), and 21% active smokers. Mean FEV1, 48.2% (±18.7). Mean exacerbations in the first period, 2.86 (±2.29) and in the second 1.36 (±1.56) (P<.001). Mean hospital admissions in the first and second period, 0.56 (±0.94) and 0.31 (±0.66) (P<.001), respectively. The decrease in the number of exacerbations was directly associated with having ≥2 exacerbations in the first period, reviewed in Primary Care, and inversely with heart failure and with having ≥2 exacerbations in the second period (R2=0.28; P<.001) CONCLUSIONS: The number of exacerbations and admissions decreased significantly in both periods assessed. However, the evaluated process indicators did not improve. Prospective intervention studies are necessary to establish the possible causal relationship.