Evaluación de una intervención educativa grupal en el control de pacientes con riesgo cardiovascular / Evaluation of an educational group intervention in the control of patients with cardiovascular risk

Objetivo: Comparar una intervención educativa grupal frente a una atención individual para mejorar variables clínicas y de gestión, en pacientes con riesgo cardiovascular (RCV) atendidos en Atención Primaria (AP).MétodoEstudio experimental controlado aleatorizado realizado en 7 centros de AP de Barcelona. Se seleccionaron 2.127 pacientes incluidos en el protocolo de patologías crónicas de los centros. El grupo intervención (GI) durante un año recibió atención educativa en cuatro talleres grupales conducidos por sus enfermeras referentes. Las variables medidas en el GI y el grupo control (GC) al inicio del estudio y tres meses tras la intervención fueron clínicas y de gestión (número visitas, gasto farmacéutico, dedicación/tiempo enfermería). Se analizaron los resultados pre-post-intervención y entre GI y GC.ResultadosEl GI inicial (n=672) al final del seguimiento perdió 144 pacientes que no cumplieron la totalidad de sesiones. El GC no sufrió pérdidas (n=824). Al final del seguimiento no hubo diferencias significativas en las variables clínicas. El número de visitas y el gasto farmacéutico se incrementó en el GI. Sin embargo, la dedicación anual enfermera/paciente/año fue de 39,59 minutos en el GI y de 60 minutos en el GC.ConclusionesEl control grupal en AP de pacientes con RCV ahorra tiempo al colectivo de enfermería respecto al control individual, sin perjuicio del grado de control del paciente. A pesar de ello, son necesarios más estudios para definir mejor que tipo de paciente es más susceptible de abordar el control de su enfermedad cardiovascular mediante talleres grupales y si esta reducción repercute en el consumo de otros recursos asistenciales(AU)

Objective: To compare an educational group intervention with individual care to improve clinical and management variables among patients with cardiovascular risk (CVR) in community health care (PC).MethodsA randomised controlled experimental study was developed in 7 PC centres of Barcelona (Spain). A total of 2,127 patients included in the chronic diseases protocol of the centres were selected. The intervention group (IG) attended four educative workshops led by their nurses during one year. Clinical and management variables (number of visits, pharmaceutical expenditure, nurse time consumption) were measured at baseline and 3 months after the intervention in the IG and in the control group (CG). Pre-post-intervention and IG vs. CG differences were analysed.ResultsAmong the 672 patients belonging to the IG, 144 were lost due to failing to attend the workshops. CG (n=824) had no withdrawals. At the end of follow-up there were no significant differences between their clinical variables. The number of visits and pharmaceutical expenditure increased in the IG. However, the annual dedication of nurses per patient per year was 39.59minutes in the IG and 60minutes in the CG.ConclusionsNurse group control of patients with CVR in PC saves nurse-time compared with the usual individual visits. However, further studies are needed to better define what type of patient that is more susceptible to follow cardiovascular control through group workshops and whether this time-saving is related to the use of other health resources(AU)

[Evaluation of an educational group intervention in the control of patients with cardiovascular risk]. / Evaluación de una intervención educativa grupal en el control de pacientes con riesgo cardiovascular.

OBJECTIVE: To compare an educational group intervention with individual care to improve clinical and management variables among patients with cardiovascular risk (CVR) in community health care (PC). METHODS: A randomised controlled experimental study was developed in 7 PC centres of Barcelona (Spain). A total of 2,127 patients included in the chronic diseases protocol of the centres were selected. The intervention group (IG) attended four educative workshops led by their nurses during one year. Clinical and management variables (number of visits, pharmaceutical expenditure, nurse time consumption) were measured at baseline and 3 months after the intervention in the IG and in the control group (CG). Pre-post-intervention and IG vs. CG differences were analysed. RESULTS: Among the 672 patients belonging to the IG, 144 were lost due to failing to attend the workshops. CG (n=824) had no withdrawals. At the end of follow-up there were no significant differences between their clinical variables. The number of visits and pharmaceutical expenditure increased in the IG. However, the annual dedication of nurses per patient per year was 39.59 minutes in the IG and 60 minutes in the CG. CONCLUSIONS: Nurse group control of patients with CVR in PC saves nurse-time compared with the usual individual visits. However, further studies are needed to better define what type of patient that is more susceptible to follow cardiovascular control through group workshops and whether this time-saving is related to the use of other health resources.

Protocolo de actuación ENLACE-PREALT / Care protocol ENLACE-PREALT

El programa de preparación al alta (PREALT) del CatSalut, dirigido a los pacientes que postalta hospitalaria precisan atención domiciliaria en 24-48 h por Atención Primaria, es un instrumento que mejora la coordinación entre los distintos niveles asistenciales. Se percibió la necesidad de ampliarlo con el concepto de ENLACE: garantizar visita a domicilio o en el centro de salud en menos de cinco días naturales, para dar continuidad asistencial a todos los pacientes que postalta hospitalaria requieran continuidad de cuidados.Al mismo tiempo se perfiló con la bidireccionalidad, que permite el flujo de información entre Atención Primaria (AP) y especializada en ambos sentidos. Entre 2007-2008 las enfermerasde enlace de AP valoraron 1.282 pacientes. 298 pacientes precisaron PREALT y 570 ENLACE. Se encuestaron 202 personas que valoraron con una media de 9,3 (en una escala de de 0 a 10) este proyecto de coordinación. La valoración holística y el seguimiento querealiza la enfermera de enlace de AP con perspectiva primarista al paciente ingresado en el hospital, aporta un valor añadido tanto alequipo de Atención Primaria como al paciente y fomenta su autonomía (AU)

The preparation program on discharge (PREALT-Preparation on Discharge)from the CatSalut (Catalan Health Service) is aimed at patients that are discharged from the hospital and who need domiciliary primary care for 24-48 hours after leaving the hospital. The program is a tool that improves coordination among the different healthcare levels. A need to extend the program was detected and the concept of LIAISON nursing was included in the program: ensuring follow up visits at home or at the primary care centre in less than five natural days to provide continuity of care to all those patients who following their hospital discharge are in need of care.The program was simultaneously designed using the bi-directionality allowed by the flow of information between Primary Care (PC)and Specialised Care in both directions. Between 2007-2008, PCliaison nurses assessed 1.282 patients. 298 required PREALT and 570LIAISON. 202 subjects were interviewed regarding the above mentioned coordination project with a mean of 9,3 (on a scale from de0 to 10). The holistic assessment and the follow up carried out by the PC liaison nurse with a primarist perspective on the hospitalised patient provides an added value both to the primary care teamand to the patient promoting his or her self-autonomy (AU)