[Utility and validity of indicators from the Nursing Outcomes Classification as a support tool for diagnosing Ineffective Self Health Management in patients with chronic conditions in primary health care]. / Utilidad y validez de un instrumento basado en indicadores de la Nursing Outcomes Classification como ayuda al diagnóstico de pacientes crónicos de At.

BACKGROUND: Self-care and management of therapeutic regime (drugs adherence, preventive behaviours and development of healthy life-styles) are key components for managing chronic diseases. Nursing has standardized languages which describe many of these situations, such as the diagnosis "Ineffective Self Health Management" (ISHM) or many of the Nursing Outcomes Classification (NOC) indicators. The aims of this study were to determine the interobserver reliability of a NOC-based instrument for assessment and aid in diagnosis of the ISHM in patients with chronic conditions in Primary Health Care, to determine its diagnostic validity and to describe the prevalence of patients with this problem. METHODS: Cross-sectional validation study developed in the provinces of Málaga, Cádiz and Almería from 2006 to 2009. Each patient was assessed by 3 independent observers: the first two observers evaluated scoring of the NOC indicators and the third one acted as the "gold-standard". RESULTS: Two hundred and twenty-eight patients were included, 37.7% of them with more than one chronic condition. NOC indicators showed a high interobserver reliability (ICC>0,70) and a consistency (Cronbach's alpha: 0.81). With a cut-point of 10.5, sensitivity was 61% and specificity 85%, and the area under the curve was 0.81 (CI95%: 0.77 to 0.85). The prevalence of patients with ISHM was 36% (CI 95%: 34 to 40). CONCLUSIONS: The use of NOC indicators allows evaluation of management of the therapeutic regime in people with chronic conditions with a satisfactory validity and it provides new approaches for dealing with this problem.

Utilidad y validez de un instrumento basado en indicadores de la Nursing Outcomes Classification como ayuda al diagnóstico de pacientes crónicos de Atención Primaria con gestión ineficiente de la salud propia / Utility and validity of indicators from the Nursing Outcomes Classification as a support tool for diagnosing Ineffective Self Health Management in patients with chronic conditions in Primary Health Care

Fundamento. El autocuidado y el manejo del régimen terapéutico por parte del paciente (adherencia a su medicación, conductas preventivas y desarrollo de estilos de vida saludables) son componentes clave del abordaje de las enfermedades crónicas. La enfermería dispone de lenguajes estandarizados para describir muchas de estas situaciones, como el diagnóstico ”gestión ineficiente dela propia salud” (GIPS) o muchos indicadores de la Clasificación de Resultados de Enfermería (NOC). Los objetivos de este estudio, pretenden conocer la fiabilidad inter observador de un instrumento de valoración y ayuda al diagnóstico de la GIPS en pacientes crónicos que acuden a consultas de Atención Primaria, basado en indicadores NOC, además de determinar su validez diagnóstica y describir la prevalencia de pacientes con este problema. Material y métodos. Estudio observacional transversal de validación, en las provincias de Málaga, Cádiz y Almería durante los años 2006 a 2009. Cada paciente era valorado por 3 observadores de forma independiente: una pareja evaluaba la puntuación de los distintos indicadores y un tercer observador experto actuaba como patrón oro .Resultados. Doscientos veintiocho pacientes fueron incluidos, con un 37,7% de ellos con más de un proceso crónico concomitante. Los indicadores NOC mostraron una alta fiabilidad inter observador (CCI>0,70) y una consistencia interna buena (alfa de Cronbach:0,81). Con un punto de corte en 10,5, se obtuvo una sensibilidad del61% y una especificidad del 85%, con un área bajo la curva de 0,81(IC95%: 0,77 a 0,85). La prevalencia de pacientes con GIPS fue del36% (IC 95%: 34 a 40).Conclusiones. El uso de indicadores de la NOC permite valorar el manejo del régimen terapéutico en pacientes crónicos, con una validez aceptable y aporta nuevos enfoques para el abordaje de este problema(AU)

Background. Self-care and management of therapeutic regime(drugs adherence, preventive behave ours and development of healthy life-styles) are key components for managing chronic diseases. Nursing has standardized languages which describe many of these situations, such as the diagnosis “Ineffective Self Health Management” (ISHM) or many of the Nursing Outcomes Classification (NOC) indicators. The aims of this study were to determine the inter observer reliability of a NOC-based instrument for assessment and aid in diagnosis of the ISHM in patients with chronic conditions in Primary Health Care, to determine its diagnostic validity and to describe the prevalence of patients with this problem. Methods. Cross-sectional validation study developed in the provinces of Málaga, Cádiz and Almería from 2006 to 2009. Each patient was assessed by 3 independent observers: the first twoobservers evaluated scoring of the NOC indicators and the third one acted as the “gold-standard”. Results. Two hundred and twenty-eight patients were included,37.7% of them with more than one chronic condition. NOC indicators showed a high inter observer reliability (ICC>0,70) and a consistency (Cronbach’s alpha: 0.81). With a cut-point of 10.5,sensitivity was 61% and specificity 85%, and the area under the curve was 0.81 (CI95%: 0.77 to 0.85). The prevalence of patients with ISHM was 36% (CI 95%: 34 to 40).Conclusions. The use of NOC indicators allows evaluation of management of the therapeutic regime in people with chronic conditions with a satisfactory validity and it provides new approaches for dealing with this problem(AU)