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BACKGROUND: Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. METHODS: The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin. RESULTS: The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation. CONCLUSION: PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.
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Educación de Pregrado en Medicina , Educación Médica , Estudiantes de Medicina , Humanos , Aprendizaje , Aprendizaje Basado en ProblemasRESUMEN
OBJECTIVE: Implementation of an advance care planning (ACP) program for people with advanced chronic conditions is a complex process. The aims of this paper are to describe (1) the development of the ACP program in Catalonia, Spain, for patients with advanced chronic conditions and complex needs and (2) the preliminary results of the implementation of this program in health and social services. METHOD: The ACP program was developed and implemented in a four-stage process as follows: (1) design and organization of the project; (2) selection of the professionals to carry out the project; (3) creation of four working groups to develop the conceptual model, guidelines, training program, and perform a qualitative evaluation; and (4) project implementation. RESULT: The following deliverables were completed: (1) conceptual framework document; (2) practical guidelines for the application of the ACP; (3) online training course (3,763 healthcare professionals completed the online course, with an overall satisfaction rating of 8.4 on a 10-point scale); and (4) additional training activities (conferences, short courses, and seminars) in between 2015 and 2017. SIGNIFICANCE OF RESULTS: This project was led by the Catalan Ministry of Health. The strengths of the project development include the contribution of a wide range of professionals from the entire region, approval by the Catalan Bioethics Committee and the Social Services Ethics Committee, and the ongoing validation by members of the community. A standardized online training course was offered to all primary care professionals and included as a quality indicator for continuing education for those professionals in the period 2016-2020. The main outcome of this project is the establishment of a pragmatic ACP throughout the region and training of the health and social care professionals involved in the care of advanced chronic patients.
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Planificación Anticipada de Atención , Cuidados Paliativos/métodos , Enseñanza/normas , Grupos Focales/métodos , Educación en Salud/métodos , Humanos , Internet , Desarrollo de Programa/métodos , Investigación Cualitativa , EspañaRESUMEN
OBJECTIVE: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION: Three Primary Care teams of Osona (Catalonia). PARTICIPANTS: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.
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Enfermedad Crónica/epidemiología , Cuidados Paliativos , Atención Primaria de Salud , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , España/epidemiología , Análisis de SupervivenciaRESUMEN
OBJECTIVE: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. DESIGN: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. LOCATION: Three primary care teams (EAP) of Osona, Cataluña. PARTICIPANTS: 224 people identified as advanced patients through a systematic population strategy. MAIN MEASUREMENTS: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). RESULTS: Patients made an average of 1.1 admissions per year (average stay=6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p<0.001), living in a nursing-home facility (p<0.001) and over-aging (p<0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p<0.05). CONCLUSIONS: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it.
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Enfermedad Crónica/terapia , Servicios de Salud Comunitaria/economía , Utilización de Instalaciones y Servicios/economía , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Costos de la Atención en Salud , Cuidados Paliativos/economía , Anciano , Estudios de Cohortes , Humanos , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM: To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN: Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS: Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS: Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION: SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
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Enfermedad Crónica/terapia , Cuidados Paliativos , Encuestas y Cuestionarios/normas , Anciano , Enfermedad Crónica/mortalidad , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Planificación de Atención al Paciente , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo/métodosRESUMEN
AIM: To understand the experiences of patients and caregivers living with advanced chronic obstructive pulmonary disease, the impact of their symptoms and care needs arising from a functional, emotional, and social context. DESIGN: Qualitative study. Phenomenological perspective. Data were collected during 2013-2015. SETTING: Primary, secondary and intermediate care. Osona (Barcelona). PARTICIPANTS: The study included 10 Primary Care patients with advanced chronic obstructive pulmonary disease, their respective 10 caregivers, and 19 primary care professionals, as well as 2 lung specialists, 2 palliative care professionals involved in their care, and one clinical psychologist. METHOD: Theoretical sampling. Semi-structured and in-depth interviews with patients, caregivers, and professionals (47 interviews). RESULTS: The emergent topics identified in patients and caregivers interviews refer to dyspnoea, the predominant symptom without effective treatment and with a major impact on patients and caregivers lives. A symptom with great functional, emotional and social repercussions to which they need to adapt in order to survive. CONCLUSIONS: Beyond pharmacological measures to control respiratory symptoms, proper care of patients with chronic obstructive pulmonary disease, requires understanding of suffering, the losses and limitations that it causes in their lives and those of their caregivers. A palliative, holistic and closer approach to their real experiences, together with an empowerment to adapt to debilitating symptoms, could contribute to a better life in the end-stages of the disease.
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Actitud Frente a la Salud , Cuidadores , Disnea/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Salud de la Familia , Femenino , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/terapia , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted. AIM: Determine, by direct measurement, the prevalence of people in need of palliative care among advanced chronically ill patients in a whole geographic population. DESIGN: Cross-sectional, population-based study. MAIN OUTCOME MEASURE: prevalence of advanced chronically ill patients in need of palliative care according to the NECPAL CCOMS-ICO(©) tool. NECPAL+ patients were considered as in need of palliative care. SETTING/PARTICIPANTS: County of Osona, Catalonia, Spain (156,807 inhabitants, 21.4% > 65 years). Three randomly selected primary care centres (51,595 inhabitants, 32.9% of County's population) and one district general hospital, one social-health centre and four nursing homes serving the patients. Subjects were all patients attending participating settings between November 2010 and October 2011. RESULTS: A total of 785 patients (1.5% of study population) were NECPAL+: mean age = 81.4 years; 61.4% female. Main disease/condition: 31.3% advanced frailty, 23.4% dementia, 12.9% cancer (ratio of cancer/non-cancer = 1/7), 66.8% living at home and 19.7% in nursing home; only 15.5% previously identified as requiring palliative care; general clinical indicators of severity and progression present in 94% of cases. CONCLUSIONS: Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies.
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Enfermedad Crónica/epidemiología , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , España/epidemiologíaRESUMEN
Palliative care must be early applied to all types of advanced chronic and life limited prognosis patients, present in all health and social services. Patients' early identification and registry allows introducing palliative care gradually concomitant with other measures. Patients undergo a systematic and integrated care process, meant to improve their life quality, which includes multidimensional assessment of their needs, recognition of their values and preferences for advance care planning purposes, treatments review, family care, and case management. Leaded by the National Department of Health, a program for the early identification of these patients has been implemented in Catalonia (Spain). Although the overall benefits expected, the program has raised some ethical issues. In order to address these challenges, diverse institutions, including bioethics and ethics committees, have elaborated a proposal for the program's advantages. This paper describes the process of evaluation, elaboration of recommendations, and actions done in Catalonia.
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Planificación Anticipada de Atención/ética , Planificación Anticipada de Atención/organización & administración , Enfermedad Crónica/terapia , Enfermería de Cuidados Paliativos al Final de la Vida/ética , Enfermería de Cuidados Paliativos al Final de la Vida/organización & administración , Cuidados Paliativos/ética , Cuidados Paliativos/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , España , Encuestas y CuestionariosRESUMEN
The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.
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Enfermedad Crónica/terapia , Cuidados Paliativos , Prestación Integrada de Atención de Salud , Europa (Continente) , Política de Salud , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/legislación & jurisprudenciaRESUMEN
In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care (PC) model, organization, and policy. As the concept of PC has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care PC model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated PC approach strategies for individuals with advanced chronic conditions. The program included epidemiologic research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO(©)) to identify individuals in the community in need of PC. Other innovations to emerge from this project to improve PC provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a PC program can respond and adapt to emerging needs and demands. The success of the PC approach described here supports more widespread adoption by other key care programs, particularly chronic care programs.
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Cuidados Paliativos , Organización Mundial de la Salud , Investigación Biomédica , Educación de Postgrado en Medicina , Diseño de Investigaciones Epidemiológicas , Humanos , Cuidados Paliativos/métodos , EspañaRESUMEN
INTRODUCTION: The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011-2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. METHOD: The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. RESULTS: It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. DISCUSSION: The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.
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Objetivo: Describir el uso de dispositivos sanitarios de las personas con cronicidad avanzada, cuantificando y caracterizando el coste de dicho consumo para sugerir mejoras en los modelos de atención. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con cronicidad avanzada. Emplazamiento: Tres equipos de atención primaria (EAP) de Osona, Cataluña. Participantes: Un total de 224 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática. Mediciones principales: Edad, sexo, tipo de domicilio, trayectoria final de vida; uso, tipo y coste de los recursos en atención primaria, urgencias, por equipos de paliativos o de hospitalización (en agudos o atención intermedia). Resultados: Se realizaron una media de 1,1 ingresos al año (estancia media = 6 días), el 74% en hospitales de atención intermedia. El 93,4% del tiempo los pacientes vivieron en la comunidad, realizando un contacto semanal con el EAP (45,1% en domicilio). El coste medio diario fue 19,4euros, siendo los principales capítulos la hospitalización de atención intermedia (36,5%), la actividad EAP (29,4%) y los ingresos en agudos (28,6%). Los determinantes de menor coste serían la trayectoria fragilidad/demencia (p < 0,001), vivir en una residencia (p < 0,001) y el sobreenvejecimiento (p < 0,001). Hay ciertas diferencias en el comportamiento de los EAP en el coste global y en recursos comunitarios (p < 0,05). Conclusiones: Los consumos en hospitalización intermedia y atención primaria son más relevantes que las estancias en centros de agudos. Los contextos residencial y domiciliario son importantes para atender con efectividad y eficiencia, especialmente cuando los EAP se preparan para ello
Objective: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. Design: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. Location: Three primary care teams (EAP) of Osona, Cataluña. Participants: 224 people identified as advanced patients through a systematic population strategy. Main measurements: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). Results: Patients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05). Conclusions: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it
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Humanos , Enfermedad Crónica/economía , Equipos y Suministros/economía , Estudios de Cohortes , Modelos de Atención de Salud , Atención Primaria de Salud/economía , Recursos en Salud/economía , Estudios Prospectivos , Análisis de Varianza , Planificación en Salud/economía , Recursos en Salud/estadística & datos numéricosRESUMEN
Objetivo: Determinar prevalencias y perfiles de las personas con enfermedades crónicas avanzadas en atención primaria y analizar elementos relacionados con su mortalidad para orientar estrategias de mejora. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con necesidades paliativas. Emplazamiento: Tres equipos de atención primaria del Área de Gestión Asistencial de Osona (Cataluña). Participantes: Un total de 251 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática que incluye el test NECPAL. Mediciones principales: Perfil demográfico y clínico básico (edad, sexo, tipo de domicilio, nivel de estratificación y enfermedad principal); fecha, lugar y causa de los eventuales fallecimientos. Resultados: El 1% de la población adulta analizada presenta enfermedades avanzadas. El 56,6% son mujeres, con una mediana de edad de 85 años. El 49,3% son personas con demencia o fragilidad avanzada, el 13,7% tienen cáncer. El 24,3% viven en residencias. La mortalidad acumulada a los 3 años es del 62,1%, con una mediana de supervivencia de 23 meses. Los factores significativamente relacionados con la probabilidad de morir son tener cáncer, el sexo femenino y el sobreenvejecimiento. Los pacientes fallecen en su domicilio (47,3%), en un hospital de atención intermedia (37,2%) o en un hospital de agudos (15,5%) en función de determinados factores explicativos. Conclusiones: En la población analizada la prevalencia y características de la enfermedad avanzada comunitaria coinciden con la reportada en la literatura. La atención primaria es el nivel de atención potencialmente referente de estos pacientes, especialmente si incorpora el entorno residencial en su ámbito de actuación
Objective: To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. Design: An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. Location: Three Primary Care teams of Osona (Catalonia). Participants: A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. Main measurements: Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. Results: 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. Conclusions: The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice
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Humanos , Masculino , Femenino , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Enfermedad Crónica/mortalidad , Cuidados Paliativos/tendencias , Atención Primaria de Salud , Estudios Prospectivos , 28599RESUMEN
BACKGROUND AND OBJECTIVE: Around 75% of the population in our country will die as a consequence of chronic advanced diseases. Advanced chronic care is one of the major challenges for public health systems. This study describes the development of a tool to identify patients with advanced chronic diseases and life limited prognosis that might require some type of palliative intervention in our health and social environment. MATERIAL AND METHODS: Spanish translation of PIG/GSF, cultural and clinical adaptation, identification of indicators of severity and progression -general and specific-; study of content validity and pre-test. RESULTS: The NECPAL CCOMS-ICO(©) tool proposes a quantitative-qualitative, multifactorial, indicative and not dichotomous evaluation combining subjective perception assessment (surprise question) with demand and perceived needs; parameters of severity and progression, geriatric syndromes, emotional aspects, comorbidity and use of resources; and indicators for selected pathologies. CONCLUSIONS: The NECPAL CCOMS-ICO(©) tool, feasible and easy to use, would identify patients with advanced chronic palliative needs of any cause, early and in all resources.
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Enfermedad Crónica , Necesidades y Demandas de Servicios de Salud , Cuidados Paliativos , Selección de Paciente , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Comorbilidad , Emociones , Indicadores de Salud , Humanos , Esperanza de Vida , Pronóstico , España/epidemiologíaRESUMEN
Palliative care (PC) has focused on patients with cancer within specialist services. However, around 75% of the population in middle-income and high-income countries die of one or more chronic advanced diseases. Early identification of such patients in need of PC becomes crucial. In this feature article we describe the initial steps of the NECPAL (Necesidades Paliativas [Palliative Needs]) Programme. The focus is on development of the NECPAL tool to identify patients in need of PC; preliminary results of the NECPAL prevalence study, which assessed prevalence of advanced chronically ill patients within the population and all socio-health settings of Osona; and initial implementation of the NECPAL Programme in the region. As first measures of the Programme, we present the NECPAL tool. The main differences from the British reference tools on which NECPAL is based are highlighted. The preliminary results of the prevalence study show that 1.45% of the total population and 7.71% of the population aged over 65 are 'surprise question' positive, while 1.33% and 7.00%, respectively, are NECPAL positive, and surprise question positive with at least one additional positive parameter. More than 50% suffer from geriatric pluri-pathology conditions or dementia. The pilot phase of the Programme consists of developing sectorised policies to improve PC in three districts of Catalonia. The first steps to design and implement a Programme to improve PC for patients with chronic conditions with a public health and population-based approach are to identify these patients and to assess their prevalence in the healthcare system.
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Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Necesidades y Demandas de Servicios de Salud , Cuidados Paliativos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comparación Transcultural , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Anciano Frágil , Encuestas Epidemiológicas , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Garantía de la Calidad de Atención de Salud/organización & administración , Mejoramiento de la Calidad , España , Traducción , Adulto JovenRESUMEN
Introducción. En tiempos donde los condicionantes demográficos, epidemiológicos, socioeconómicos y tecnológicos determinan fuertemente la manera en que se ejerce la medicina, foros como el Congreso de la Profesión Médica de Catalunya pueden aportar luz en los nuevos enfoques que exige el profesionalismo médico actual y futuro. Objetivo. Mostrar el proceso y las conclusiones de un consenso, llevado a cabo en la edición 2016 del congreso, acerca de los nuevos retos del profesionalismo y del perfil del médico que la sociedad de las próximas décadas va a necesitar. Sujetos y métodos. Se lleva a cabo un proceso participativo y estructurado de consenso, implementado en tres fases consecutivas: panel de expertos, peer-review telemático y debate intracongresual. Resultados. La participación activa de 21 expertos, de 2.025 aportaciones telemáticas y de 131 delegados congresuales genera un documento de propuestas compartidas que cuenta con índices de aprobación cercanos al 95% y que permite identificar y priorizar los retos percibidos en el profesionalismo y los atributos de los médicos del futuro reciente. Conclusiones. El profesionalismo médico se verá directamente interpelado por las nuevas condiciones sociales y por las nuevas propuestas para los sistemas sanitarios del futuro, donde los elementos de empoderamiento ciudadano, de toma compartida de decisiones clínicas, de prácticas colaborativas y marcos éticos impecables, asociados a una apuesta decidida por posiciones de liderazgo profesional y social del colectivo médico, van a constituir el contexto emergente de la práctica de la medicina, al que las organizaciones docentes deberán adaptarse (AU)
Introduction. In times where demographic, epidemiological, socio-economic and technological conditions strongly determine the way in which medicine is practiced, forums such as the Congress of the Medical Profession of Catalonia can inform on the new approaches required by current and future medical professionalism. Aim. To show the process and the conclusions of a consensus, carried out in the 2016 edition of the Congress, about the new challenges of professionalism and the profile of the physician that the Catalan society will need the next decades. Subjects and methods. A participatory and structured consensus process is implemented in three consecutive phases: expert panel, telematic peer-review and intra-congressional debate. Results. The active participation of 21 experts, 2,025 telematic contributions and 131 congressional delegates generated a document of shared proposals that has approval rates around 95% and that allows the identification and prioritization of the perceived challenges in professionalism and the attributes of physicians for the recent future. Conclusions. Medical professionalism will be directly challenged by the new social conditions and by the proposals for the health systems of the future, where the elements of citizen empowerment, of shared decision-making procedures, of collaborative practices in impeccable ethical frameworks and solid positions of professional and social leadership of doctors will constitute the emerging context of the practice of medicine, to which teaching organizations will have to adapt (AU)
Asunto(s)
Humanos , Empleos en Salud/educación , Empleos en Salud/normas , Conferencias de Consenso como Asunto , Educación Médica/organización & administración , Educación Médica/normas , Organizaciones de Normalización Profesional/organización & administración , Organizaciones de Normalización Profesional/normasRESUMEN
PURPOSE OF REVIEW: We describe conceptual innovations in palliative care epidemiology and the methods to identify patients in need of palliative care, in all settings.In middle-high-income countries, more than 75% of the population will die from chronic progressive diseases. Around 1.2-1.4% of such populations suffer from chronic advanced conditions, with limited life expectancy. Clinical status deteriorates progressively with frequent crises of needs, high social impact, and high use of costly healthcare resources. RECENT FINDINGS: The innovative concept of patients with advanced chronic diseases and limited life prognosis has been addressed recently, and several methods to identify them have been developed. SUMMARY: The challenges are to promote early and shared interventions, extended to all patients in need, in all settings of the social care and healthcare systems; to design and develop Palliative Care Programmes with a Public Health perspective. The first action is to identify, using the appropriate tools early in the clinical evolution of the disease, all patients in need of palliative care in all settings of care, especially in primary care services, nursing homes, and healthcare services responsible for care provision for these patients; to promote appropriate care in patients with advanced diseases with prognosis of poor survival.
Asunto(s)
Servicios de Salud Comunitaria , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Cuidados Paliativos/métodos , Salud Pública/métodos , Calidad de la Atención de Salud/normas , Enfermedad Crónica , Humanos , Cuidados Paliativos/normas , Pronóstico , Medición de Riesgo/métodosRESUMEN
OBJECTIVO: Conocer las experiencias de pacientes y cuidadores que conviven con la enfermedad pulmonar obstructiva crónica avanzada, el impacto de sus síntomas y las necesidades de atención que generan en su contexto funcional, emocional y social. DISEÑO: Estudio cualitativo. Perspectiva fenomenológica. Recogida de datos durante 2013-2015. EMPLAZAMIENTO: Atención primaria, hospitalaria e intermedia. Osona (Barcelona). PARTICIPANTES Y/O CONTEXTOS: Diez pacientes de atención primaria con enfermedad pulmonar obstructiva crónica avanzada, 10 cuidadores principales respectivos y 19 profesionales de atención primaria, 2 neumólogos, 2 de cuidados paliativos, implicados en su atención y un psicólogo clínico. MÉTODO: Muestreo teórico. Entrevistas semiestructuradas y en profundidad a pacientes, cuidadores y profesionales (47 entrevistas). RESULTADOS: Las temáticas emergentes identificadas en las entrevistas de pacientes y cuidadores hacen referencia a la disnea, síntoma predominante sin un tratamiento efectivo y con un gran impacto en la vida de pacientes y cuidadores. Un síntoma con gran repercusión funcional, emocional y social al que es necesario adaptarse para sobrevivir. CONCLUSIONES: La atención adecuada de los pacientes con enfermedad pulmonar obstructiva crónica, más allá de las medidas farmacológicas para controlar los síntomas respiratorios, pasa por la comprensión del sufrimiento, las pérdidas y las limitaciones que provoca en sus vidas y las de sus cuidadores. Un abordaje paliativo, holístico y cercano a sus vivencias reales, junto al empoderamiento para la adaptación a los síntomas debilitantes, podría contribuir a una vida mejor en la etapa final de la enfermedad
AIM: To understand the experiences of patients and caregivers living with advanced chronic obstructive pulmonary disease, the impact of their symptoms and care needs arising from a functional, emotional, and social context. DESIGN: Qualitative study. Phenomenological perspective. Data were collected during 2013-2015. SETTING: Primary, secondary and intermediate care. Osona (Barcelona). PARTICIPANTS. The study included 10 Primary Care patients with advanced chronic obstructive pulmonary disease, their respective 10 caregivers, and 19 primary care professionals, as well as 2 lung specialists, 2 palliative care professionals involved in their care, and one clinical psychologist. METHOD: Theoretical sampling. Semi-structured and in-depth interviews with patients, caregivers, and professionals (47 interviews). RESULTS: The emergent topics identified in patients and caregivers interviews refer to dyspnoea, the predominant symptom without effective treatment and with a major impact on patients and caregivers lives. A symptom with great functional, emotional and social repercussions to which they need to adapt in order to survive. CONCLUSIONS: Beyond pharmacological measures to control respiratory symptoms, proper care of patients with chronic obstructive pulmonary disease, requires understanding of suffering, the losses and limitations that it causes in their lives and those of their caregivers. A palliative, holistic and closer approach to their real experiences, together with an empowerment to adapt to debilitating symptoms, could contribute to a better life in the end-stages of the disease