Nursing workload predictors in Catalonia (Spain): a home care cohort study

Objective: To identify the characteristics of chronic patients and their environment in order to predictthe nursing workload required 1 year after their inclusion in a home care program.Methods: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain)with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected fromeach patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer,Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services,self-perceived health (SF-12) and the number of health worker visits.Results: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender(IRR = 1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR = 1.65, 95%CI: 1.29-2.13), decubitusulcers (IRR = 4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR = 1.65, 95%CI:1.31-2.07). In contrast, patients with major cognitive impairment (IRR = 0.78, 95%CI: 0.63-0.98) had alower probability of receiving nursing visits at home.Conclusions: Workload can be predicted by patients’ clinical characteristics. The positive correlation ofworkload with variables related to disease severity and the negative correlation with variables relatedto cognitive impairment show that home care nursing in Catalonia is basically demand-oriented (AU)

Objetivo: Identificar las características basales de los pacientes crónicos y su entorno que predicen la cargade trabajo de enfermería durante el a˜no siguiente a su inclusión en un programa de atención domiciliaria(ATDOM).Métodos: Estudio longitudinal realizado en 72 equipos de atención primaria de salud en Catalu˜na.Seguimiento durante un a˜no de 1068 pacientes de ATDOM mayores de 64 a˜nos de edad. Variables recogidas:nivel de salud y situación social (test de Charlson, Barthel, Pfeiffer, Braden y Gijón); sobrecarga delcuidador (Test de Zarit); ingresos hospitalarios y visitas a urgencias; estado subjetivo de salud (SF-12);visitas de los profesionales de salud.Resultados: Los pacientes recibieron 7,2 (DE: 10,4) visitas anuales de su enfermera habitual. Observamosque tienen más riesgo de recibir visitas de enfermería los pacientes varones (IRR = 1,42, IC95%: 1,20-1,67), con dependencia para las actividades de la vida diaria (IRR = 1,65, IC95%: 1,29-2,13), afectados porúlceras por decúbito (IRR = 4,03, IC95%: 2,27-7,14) y que precisaron servicios de atención de urgencia adomicilio (IRR = 1,65, IC95%: 1,31-2,07). Por otro lado, los pacientes con deterioro cognitivo importantetienen menos probabilidad de recibir visitas de su enfermera (IRR = 0,78, IC95%: 0,63-0,98).Conclusiones: Las características clínicas de los pacientes permiten predecir la carga de trabajo de enfermería.Esta relación positiva de la carga de trabajo con las variables relacionadas con la gravedad de laenfermedad y la relación negativa con el deterioro cognitivo muestra que la enfermería domiciliaria enCataluña está básicamente orientada a la demanda(AU)

[Health problems also explain social services use in home care]. / Los problemas de salud también explican la utilización de servicios sociales en atención domiciliaria.

OBJECTIVE: To identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law. DESIGN: Cross-sectional study. SETTING: 72 primary health care teams in Catalonia. PATIENTS: Patients over 64 years old with chronic diseases in home care programmes in Catalonia. MEASUREMENTS: Health status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital. RESULTS: A total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care. CONCLUSIONS: To be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care.

Los problemas de salud también explican la utilización de servicios sociales en atención domiciliaria / Health problems also explain social services use in home care

Objetivo: identificar las variables relacionadas con el hecho de recibir servicios sociales de carácter público o privado antes de la implantación de la Ley de Dependencia en pacientes recluidos en sus domicilios. Diseño: estudio descriptivo transversal. Emplazamiento: 72 equipos de atención primaria de Cataluña (EAP). Participantes: pacientes mayores de 64 años, no institucionalizados atendidos por un programa de atención domiciliaria de los EAP. Mediciones principales: de cada paciente se registraron: comorbilidad, estado funcional, estado cognitivo, si tenía úlceras por presión, salud subjetiva, valoración social, utilización de servicios sociales y sanitarios formales e informales, sobrecarga del cuidador, ingresos en residencias, hospitales o urgencias, además del número de visitas de profesionales santiarios. Resultados: participan 1.068 pacientes, el 46,8% recibe algún servicio social. Las variables relacionadas con la prestación de servicios sociales son: el grado de dependencia (Barthel), las úlceras por presión y recibir rehabilitación a domicilio. El test de Barthel está firmemente asociado a la problemática social (Gijón), carecer de cuidador informal, más de dos visitas de médico de familia y tener sanidad privada adicional. Conclusiones: para ser más equitativa, la valoración de las prestaciones de la Ley de Dependencia debería considerar también el estado de salud. Antes de la aplicación de esta ley se intuye una dificultad de acceso a los servicios sociales formales para las clases medias que no acceden a las prestaciones públicas ni pueden pagarlas. Las prestaciones sociales son todavía una alternativa a la atención familiar(AU)

Objective: To identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law. Design: Cross-sectional study. Setting: 72 primary health care teams in Catalonia. Patients: Patients over 64 years old with chronic diseases in home care programmes in Catalonia. Measurements: Health status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital. Results: A total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care. Conclusions: To be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care(AU)