Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos / Economic evaluation of a program of coordination between levels for complex chronic patients’ management

OBJETIVO: El programa del paciente crónico complejo (PCC) del Alt Penedès tiene por objetivo mejorar la coordinación asistencial. El objetivo del presente trabajo fue evaluar la relación entre los costes asociados al programa y sus resultados en forma de ingresos evitados. DISEÑO: Análisis coste-efectividad desde la perspectiva del sistema sanitario a partir de un estudio antes-después. Emplazamiento: Comarca del Alt Penedès. MEDICIONES PRINCIPALES: Los resultados en utilización de servicios hospitalarios (ingresos, urgencias, hospital de día) y visitas de primaria del programa PCC se compararon con los anteriores a su implementación. El coste asignado a cada recurso correspondió al concierto del hospital con CatSalut y las tarifas del ICS para atención primaria. Se llevó a cabo un análisis de sensibilidad a partir del método de bootstrapping. La intervención se consideró coste-efectiva si la ratio coste-efectividad incremental (RCEI) no superaba el coste de un ingreso (1.742,01 Euros). RESULTADOS: Se incluyó a 149 pacientes. Los ingresos se redujeron de 212 a 145. El RCEI fue 1.416,3 Euros (94.892.9 Euros/67). El análisis de sensibilidad mostró que en el 95% de los casos los costes podrían variar entre 70.847,3 Euros y 121.882,5 Euros, y los ingresos evitados entre 30 y 102. En el 72,4% de las simulaciones el programa fue coste-efectivo. CONCLUSIONES: El análisis de sensibilidad muestra que en la mayoría de situaciones el programa del PCC sería coste-efectivo, aunque en un porcentaje de casos el programa podría suponer un aumento global del coste de la atención, a pesar de suponer siempre una reducción en el número de ingresos

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (Euros 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was Euros 1,416.3 (94,892.9 Euros/67). Sensitivity analysis showed that in 95% of cases the cost might vary between Euros 70,847.3 and Euros 121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions

[Economic evaluation of a program of coordination between levels for complex chronic patients' management]. / Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos.

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (€ 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was €1,416.3 (94,892.9€/67). Sensitivity analysis showed that in 95% of cases the cost might vary between €70,847.3 and €121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions.

[Empowerment and power: their relationship in the proces of caring for the chronically ill in primary care]. / Empoderamiento y poder: su vinculación en el proceso de cuidar al enfermo crónico en atención primaria.

The concepts of "power" and "empowerment" are used in various disciplines, both political and social. Now are these terms frequently in the field of health. Our goal is to know its meaning as a synonym of expressions: "energy", "force", "domain", "vigour", "power", "capacity", "authority" and "control", which have been always within our practice nurse's own lexicon. Semantically analyzing them will help us in the understanding of its nuance. The literature review facilitates their understanding and allows us to link these words within the management of care. In this way we can propose diagnoses, interventions and outcomes specifically related to these concepts, which will help us optimize the efficiency in the management of care plans. The purpose of various collective nurses from different institutions is that the person is able to not generate dependencies and have the option of choosing your own lifestyle according to their culture and environment, independently or with the help. Generate knowledge is to generate power. The person should be educated and informed, to be expert and active and taking action to help control and minimize the progression of your health problem chronic and its possible complications. We are in the process of reformulation of the health system, whether it is private or public, and is necessary to know the power of the various actors involved in the management of the care to us. Each of these main actors--person ill, family/caregiver or nurse--has to know what is his role in this process.

Empoderamiento y poder. Su vinculación en el proceso de cuidar al enfermo crónico en atención primaria / Empowerment and power: their relationship in the process of caring for the chronically ill in primary care

Los conceptos de «poder» y «empoderamiento» se utilizan en varias disciplinas, tanto políticas como sociales. En la actualidad estos términos aparecen con frecuencia en el campo de la salud. Nuestro objetivo es conocer su significado como sinónimos de las expresiones: «energía», «fuerza», «dominio», «vigor», «potencia», «capacidad», «autoridad» y «mando», que han figurado desde siempre dentro del léxico propio de nuestra práctica enfermera. Analizarlos semánticamente nos ayudará sin duda en la aprehensión de su matiz. La revisión bibliográfica nos facilita su comprensión y nos permite vincular estos vocablos dentro de la gestión de los cuidados. De esta forma, podemos proponer diagnósticos, intervenciones y resultados relacionados específicamente con estos conceptos, que nos ayudarán a optimizar la eficiencia en la gestión de los planes de cuidados. El propósito de diversos colectivos enfermeros de diferentes instituciones es que la persona sea capaz de no generar dependencias y que tenga la opción de escoger según su cultura y entorno, de forma autónoma o con ayuda, su propio estilo de vida. Generar conocimiento es generar poder. La persona debe estar formada e informada para ser experta, activa y emprender acciones que le permitirán controlar y minimizar la progresión de su problema de salud crónico y sus posibles complicaciones. Estamos en pleno proceso de reformulación del sistema de salud, ya sea privado o público, y resulta necesario conocer el poder de los diversos actores que intervienen en la gestión de los cuidados. Cada uno de estos principales actores -persona enferma, familiar/o cuidador y enfermera- debe saber cuál es su rol en este proceso y ser consciente de su poder dentro de la escena de los cuidados (AU)

The concepts of «power» and «empowerment» are used in various disciplines, both political and social. Now are these terms frequently in the field of health. Our goal is to know its meaning as a synonym of expressions: «energy», «force», «domain», «vigour», «power», «capacity», «authority» and «control», which have been always within our practice nurse’s own lexicon. Semantically analyzing them will help us in the understanding of its nuance. The literature review facilitates their understanding and allows us to link these words within the management of care. In this way we can propose diagnoses, interventions and outcomes specifically related to these concepts, which will help us optimize the efficiency in the management of care plans. The purpose of various collective nurses from different institutions is that the person is able to not generate dependencies and have the option of choosing your own lifestyle according to their culture and environment, independently or with the help. Generate knowledge is to generate power. The person should be educated and informed, to be expert and active and taking action to help control and minimize the progression of your health problem chronic and its possible complications. We are in the process of reformulation of the health system, whether it is private or public, and is necessary to know the power of the various actors involved in the management of the care to us. Each of these main actors -person ill, family/caregiver or nurse- has to know what is his role in this process(AU)