[Management of time used to treat the chronic patient: a new approach to improve quality of health care]. / Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial.

OBJECTIVE: Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. MATERIAL AND METHODS: Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. RESULTS: In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]). CONCLUSIONS: Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.

Gestión del tiempo de asistencia al paciente crónico: un nuevo enfoque para mejorar la calidad asistencial / Management of time used to treat the chronic patient: A new approach to improve quality of health care

Objetivo. La cronicidad es la principal epidemia del siglo XXI y condiciona que gran parte de los presupuestos sociosanitarios se dediquen a su atención. El objetivo de este estudio es analizar si la calidad de la atención al paciente crónico mejora implantando tiempos asistenciales no presenciales. Material y métodos. Estudio de intervención realizado en el centro de salud de Orcasitas (enero de 2012-septiembre de 2013) en pacientes con hipertensión (357), diabetes (180) y/o cardiopatía isquémica (60). La calidad asistencial se analizó mediante la efectividad reflejada en el programa de seguimiento de objetivos en atención primaria (eSOAP). Para el grupo de intervención se establecieron 4 consultas presenciales y 3 no presenciales por año, de 10 min cada una, manteniendo el grupo control su dinámica habitual. Los datos se contrastaron mediante las pruebas de McNemar, Chi-cuadrado y Q de Cochran. Resultados. En el grupo de intervención la efectividad se incrementó en el periodo analizado un 46%, un 54% y un 55,9% respectivamente para los procesos hipertensión, diabetes y control de la dislipidemia en cardiopatía isquémica, mientras que en el grupo control (Comunidad de Madrid) fue, respectivamente, del 2,54%, 1,78% y 5,44% (diferencias estadísticamente significativas [χ2 = 24,78; χ2 = 39,9 y χ2 = 67,3, p < 0,0001]). Conclusiones. Treinta minutos/año de atención no presencial suponen un cambio relevante en el grado de control del paciente crónico. Este resultado debería ser tenido en cuenta en las estrategias de abordaje de la cronicidad (AU)

Objective. Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. Material and methods. Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10 minute consultations/year and three non-physical 10 minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. Results. In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ2 = 24.78; χ2 = 39.9 y χ2 = 67.3, P < .0001]). Conclusions. Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases (AU)