Educational diagnosis of self-management behaviours in patients with diabetes mellitus, hypertension and hypercholesterolaemia based on the PRECEDE model: Qualitative study.

AIMS AND OBJECTIVES: To identify the key factors of adopting self-care behaviours in the treatment of diabetes mellitus II, hypertension and hypercholesterolaemia when the three conditions appear simultaneously. BACKGROUND: Diabetes, hypertension and hypercholesterolaemia are chronic health problems which often appear together. The correct monitoring of these pathologies when they concur simultaneously requires specific health management behaviours, to which a significant part of the population is unable of adhering, despite recommendations from professional healthcare workers. DESIGN: A qualitative study using focus groups techniques was carried out. The elements related to the content were drafted following the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ checklist). METHODS: Patients with simultaneous diabetes, hypertension and hypercholesterolaemia, as well as nursing professionals and family doctors who have treated patients at primary care centres, were the key sources of information. The methodology used to analyse the information was content analysis. RESULTS: There were factors which can positively or negatively determine the adoption of the self-management recommendations that healthcare professionals make to patients who simultaneously have diabetes, hypertension and hypercholesterolaemia. These factors were not only associated with the patient, but also with the health carers themselves and the healthcare system and policies in force. CONCLUSIONS: When health professionals provide recommendations for self-care to people diagnosed with diabetes, hypertension and hypercholesterolaemia simultaneously, they should bear in mind not only the determinants of behaviour associated with the patient, but also those that are related to the health professionals themselves and with the healthcare system. The PRECEDE model could be a good tool to identify and design health education programs. RELEVANCE TO CLINICAL PRACTICE: The knowledge of the determinants of health behaviour of patients with chronic diseases could improve adherence patients to health recommendations, avoid associated complications and increase their quality of life.

[Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model]. / Comparación de la satisfacción de los usuarios de atención domiciliaria: modelo integrado vs. modelo dispensarizado.

OBJECTIVE: To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. DESIGN: cross-sectional, observational study. LOCATION: Two primary care centers in the province of Barcelona. PARTICIPANTS: The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. MAIN MEASUREMENTS: The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). RESULTS: The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of the CONCLUSIONS: The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions.

Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review.

BACKGROUND: Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES: To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS: The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS: Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS: Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.

Comparación de la satisfacción de los usuarios de atención domiciliaria: modelo integrado vs. modelo dispensarizado / Comparison of level of satisfaction of users of home care: Integrated model vs. dispensaries model

OBJETIVO: Comparar el grado de satisfacción de los usuarios que reciben atención domiciliaria a través de 2 modelos de atención primaria: integrado y dispensarizado. DISEÑO: Estudio transversal, observacional. Emplazamiento: Dos centros de atención primaria de la provincia de Barcelona. Participantes: Ciento cincuenta y ocho pacientes crónicos mayores de 65 años que recibían atención domiciliaria: 67 mediante el modelo integrado y 91 mediante el modelo dispensarizado. Mediciones principales: Se administró la escala de Evaluación de la Satisfacción del Servicio de Atención Domiciliaria (SATISFAD-12), así como preguntas complementarias relacionadas con la satisfacción del servicio de atención domiciliaria y características sociodemográficas. RESULTADOS: Los usuarios del modelo dispensarizado estaban más satisfechos que los del modelo integrado. Existía una mayor continuidad asistencial en el modelo dispensarizado y un menor porcentaje de ingresos hospitalarios en el último año. La satisfacción de los usuarios de ambos modelos no estaba asociada al género ni a la percepción de salud y autonomía por parte del paciente. CONCLUSIONES: El grado de satisfacción de los pacientes de atención primaria domiciliaria parece depender de las características propias de cada modelo organizativo, siendo el modelo dispensarizado el que presenta un mayor grado de satisfacción o calidad asistencial percibida. Se debería realizar un mayor número de estudios para generalizar estos resultados a otros centros de atención primaria pertenecientes a otras instituciones

OBJECTIVE: To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. DESIGN: cross-sectional, observational study. Location: Two primary care centers in the province of Barcelona. Participants: The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. Main measurements: The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). RESULTS: The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception, or independence of the. CONCLUSIONS: The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions