Estratificación de la población mayor de 65 años en grupos de riesgo clínico: características y valoración enfermera / Stratification of clinical risk groups in a population over 65 years: Features and nursing assessment

OBJETIVO: Analizar las características de la población mayor de 65 años atendida en un Área Básica de Salud según la clasificación de Clinical Risk Groups (CRG, «Grupos de Riesgo Clínico») y la valoración de los test geriátricos realizados por la enfermera en relación con la complejidad que presentan. MÉTODO: Estudio observacional, descriptivo transversal, realizado sobre la población mayor de 65 años atendidos en un Área Básica de Salud. Se recogieron variables sociodemográficas, clasificación CRG, enfermedades (CIE-10), actividad asistencial, valoración geriátrica y actividades preventivas. Se utilizó la clasificación CRG como instrumento de medida. La recogida de datos se realizó mediante la historia clínica informatizada (e-CAP) de Atención Primaria. RESULTADOS: Población mayor de 65 años: 3.219 personas; atendidas a domicilio 130 (4%), y en institución residencial, 92 (2,85%). La población se agrupó en: CRG 1-2: 83 (2,5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2077 (64,5%); CRG 7: 276 (8,6%); CRG 8: 61 (2%); CRG 9: 14 (0,4%). Las enfermedades crónicas más frecuentes fueron: 69,12% HTA, 24,94% DM, 19,51% depresión y 11,09% insuficiencia renal. Se analizaron los grupos 6-7-8, que incluían 2.414 personas (75%). De las personas con CRG 6-7-8, solamente 570 (24%) tenían test geriátricos realizados por la enfermera. La media de personas asignadas por enfermera para CRG 6-7-8 fue de 302. CONCLUSIONES: En la práctica clínica, la incorporación de sistemas de clasificación como los CRG conjuntamente con el uso de las nuevas tecnologías de la información y la comunicación permite incorporar modelos predictivos de necesidades sanitarias e impulsar acciones proactivas por parte de enfermería y del equipo para prevenir complicaciones de enfermedades, y mejorar la eficiencia tanto en la utilización de servicios como en la atención a la complejidad

OBJECTIVE: To analyze the characteristics of the population over 65 years served in a Basic Health Area, according to the Clinical Risk Group (CRG) classification and geriatric assessment test performed by the nurse in relation to their complexity. METHODS: A descriptive, cross-sectional and observational prevalence study was conducted on the population over 65 years served in a Basic Health Area. The variables collected were: socio-demographic, CRG classification, diseases (ICD-10), healthcare activity, geriatric assessment, and preventive activities. The CRG classification was used as a measurement tool. Data was collected from the Primary Care computerized clinical history (e-CAP). RESULTS: Population over 65 years: 3,219 people; served at home, 130 (4%), and in residential institutions, 92 (2.85%). The population was grouped into: CRG 1-2: 83 (2.5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2,077 (64.5%); CRG 7: 276 (8.6%); CRG 8: 61 (2%); CRG 9: 14 (0.4%). Most frequent chronic diseases: 69.12% AHT; 24.94% DM; 19.51% depression; 11.09% kidney failure. The groups 6-7-8 that were analyzed included 2,414 people (75%). Of those within CRG 6-7-8, only 570 (24%) had tests carried out by the geriatric nurse. The mean number of individuals assigned by a nurse for CRG 6-7-8 was 302. CONCLUSIONS: The introduction of classification systems in clinical practice, such as the CRG, along with the use of the new information and communication technologies, helps to incorporate predictive models of health needs. It also promotes proactive actions by nurses and the team to prevent complications of diseases, as well as improving efficiency in the use of services and in care of the complex patients

[Stratification of clinical risk groups in a population over 65 years: features and nursing assessment]. / Estratificación de la población mayor de 65 años en grupos de riesgo clínico: características y valoración enfermera.

OBJECTIVE: To analyze the characteristics of the population over 65 years served in a Basic Health Area, according to the Clinical Risk Group (CRG) classification and geriatric assessment test performed by the nurse in relation to their complexity. METHODS: A descriptive, cross-sectional and observational prevalence study was conducted on the population over 65 years served in a Basic Health Area. The variables collected were: socio-demographic, CRG classification, diseases (ICD-10), healthcare activity, geriatric assessment, and preventive activities. The CRG classification was used as a measurement tool. Data was collected from the Primary Care computerized clinical history (e-CAP). RESULTS: Population over 65 years: 3,219 people; served at home, 130 (4%), and in residential institutions, 92 (2.85%). The population was grouped into: CRG 1-2: 83 (2.5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2,077 (64.5%); CRG 7: 276 (8.6%); CRG 8: 61 (2%); CRG 9: 14 (0.4%). Most frequent chronic diseases: 69.12% AHT; 24.94% DM; 19.51% depression; 11.09% kidney failure. The groups 6-7-8 that were analyzed included 2,414 people (75%). Of those within CRG 6-7-8, only 570 (24%) had tests carried out by the geriatric nurse. The mean number of individuals assigned by a nurse for CRG 6-7-8 was 302. CONCLUSIONS: The introduction of classification systems in clinical practice, such as the CRG, along with the use of the new information and communication technologies, helps to incorporate predictive models of health needs. It also promotes proactive actions by nurses and the team to prevent complications of diseases, as well as improving efficiency in the use of services and in care of the complex patients.

[Descriptive study of ambulatory blood pressure monitoring in the Primary Care Nursing clinic]. / Estudio descriptivo de la monitorización ambulatoria de la presión arterial en la consulta de Enfermería de Atención Primaria.

OBJECTIVE: To analyze the clinical characteristics and the circadian patterns of patients who received ambulatory blood pressure monitoring (ABPM) by a Primary Care Team. METHOD: A descriptive, observational, cross-sectional study at community level. People older than 18 years on ABPM (2007-2011). VARIABLES: demographic, cardiovascular disease, diabetes mellitus, cardiovascular risk factors, any type of arterial hypertension and circadian pattern. Intruments of measurement: 2 validated instruments with comparable results were used. PROCEDURE: The instruments for ABPM were placed during the nursing visit. The instruments were then removed after 24h, and the data was retrieved and recorded in the computerized clinical history. RESULTS: A total of 326 people were studied, with a mean age of 60.53±12.96 years, of whom 56.7% were male. According to ABPM the patient results showed that: 38.5% had «white coat¼ arterial hypertension, 36.2% were classified as poorly controlled arterial hypertension, 17.2% had masked hypertension, and 8% with isolated hypertension. Dipper circadian patterns were present in 39.6% of patients and non- dipper in 60.4%. CONCLUSIONS: ABPM allows to Primary Health Care professionals to check the actual situation of the blood pressure over 24h and analyze the circadian pattern. In clinical practice this involves having a comprehensive care strategy on life style, as well as adherence to treatment.

Estudio descriptivo de la monitorización ambulatoria de la presión arterial en la consulta de Enfermería de Atención Primaria / Descriptive study of ambulatory blood pressure monitoring in the Primary Care Nursing clinic

Objetivo: Analizar las características clínicas y los patrones circadianos de las personas a las que se les ha realizado una monitorización ambulatoria de la presión arterial (MAPA) en un Equipo de Atención Primaria. Método Estudio descriptivo, transversal, realizado en el Área Básica de Salud Gavarra de Cornellà de Llobregat (Barcelona). Se seleccionaron todas las personas mayores de 18 años con una MAPA realizada entre 2007-2011. Las variables estudiadas fueron: sociodemográficas, enfermedad cardiovascular, diabetes mellitus, factores de riesgo cardiovascular, tipo de HTA y patrón circadiano. Instrumentos de medida: se utilizaron 2 aparatos validados con resultados comparables. Procedimiento Los pacientes acudían a consulta de Enfermería previa citación para colocación del aparato de MAPA. A las 24 h se retiraba y se registraban los datos en la historia clínica informatizada. Resultados Se realizaron 326 MAPA. La edad media de la población fue de 60,53 ± 12,96 años, de los cuales el 56,7% eran hombres. De acuerdo con los resultados de la MAPA se clasificaron en: HTA de bata blanca el 38,5%, HTA mal controlada el 36,2%, HTA enmascarada el 17,2% y HTA aislada el 8%. Entre los patrones circadianos se identificaron como dipper un 39,6% y non dipper un 60,4%.ConclusionesLa MAPA permite a los profesionales de Atención Primaria comprobar la situación real de la presión arterial en 24 h y analizar el patrón circadiano, lo que implica en la práctica clínica poder llevar a cabo una estrategia y abordaje integral tanto en cuidados del estilo de vida como en adherencia al tratamiento (AU)

OBJECTIVE: To analyze the clinical characteristics and the circadian patterns of patients who received ambulatory blood pressure monitoring (ABPM) by a Primary Care Team. METHOD: A descriptive, observational, cross-sectional study at community level. People older than 18 years on ABPM (2007-2011). Variables: demographic, cardiovascular disease, diabetes mellitus, cardiovascular risk factors, any type of arterial hypertension and circadian pattern. Intruments of measurement: 2 validated instruments with comparable results were used. PROCEDURE: The instruments for ABPM were placed during the nursing visit. The instruments were then removed after 24h, and the data was retrieved and recorded in the computerized clinical history. RESULTS: A total of 326 people were studied, with a mean age of 60.53±12.96 years, of whom 56.7% were male. According to ABPM the patient results showed that: 38.5% had «white coat» arterial hypertension, 36.2% were classified as poorly controlled arterial hypertension, 17.2% had masked hypertension, and 8% with isolated hypertension. Dipper circadian patterns were present in 39.6% of patients and non- dipper in 60.4%.CONCLUSIONS: ABPM allows to Primary Health Care professionals to check the actual situation of the blood pressure over 24h and analyze the circadian pattern. In clinical practice this involves having a comprehensive care strategy on life style, as well as adherence to treatment (AU)

Analisis CAME‐ DAFO del primer semestrecomo Residentes de Enfermeria Familiar y Comunitaria / CAME-WTSO analysis of the first semester as Family and Community Nursing residents

En 2010 se publica el primer programa formativo de la especialidad de Enfermería Familiar y Comunitaria. Como primera promoción de Residentes se inicia la aplicación practica de las competencias de dicho programa. Así, para recoger las experiencias del primer semestre y analizar la puesta en práctica del plan formativo se ha utilizado un análisis DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades). Se ha obtenido un total de ocho debilidades, nueve fortalezas, seis amenazas y cinco oportunidades. De todas ellas, se destaca que hay una tendencia a la especialización y como futuras especialistas se apuesta por ello. Muchos profesionales sanitarios no conocen los programas formativos de las/los residentes, no se dispone de portafolio especifico de Enfermería, sin olvidar el difícil reconocimiento profesional de la especialidad. A raíz de estos resultados se elaboró un análisis CAME (Corregir, Afrontar, Mantener y Explotar).Las conclusiones extraídas sirvieron para establecer objetivos encaminados a mejorar aspectos de la residencia basándose en la experiencia, trazar líneas que servirán para seguir desarrollándola y poder mejorarlas promociones futuras (AU)

In 2010, the first training program in the specialty of Family and Community Nursing was published. With the first class of Resident Nurses, the practical implementation of said program has been initiated. Therefore, WTSO (Weaknesses, Threats, Strengths and Opportunities) analysis has been used in order to collect the experiences in the first semester and analyze the implementation of the training plan. Eight weaknesses, nine strengths, six threats and five opportunities have been obtained in total. Of all of them, a trend towards specialization has been highlighted, and this is supported as future specialists. Many healthcare professionals are not familiar with training programs for resident nurses, there is no specific portfolio for Nursing, and we cannot forget the difficult professional acknowledgement of this specialty. Based on these results, a CAME (Correct, Adapt, Maintain and Explore) analysis was prepared. The conclusions obtained were useful to establish objectives targeted at improving aspects of the residence period based on experience, to draw lines which will be useful to continue developing it and enabling to improve the future graduated classes (AU)