RESUMO
INTRODUCTION: Institutionalized patients who require nutrition support regularly visit the Unit of Nutrition Support of the Hospital Pharmacy Service. During these visits, prior to establishing a nutrition regime and followup scheme, an initial nutritional status assessment is performed. Telemedicine and Telepharmacy have expanded in recent years for remote monitoring of institutionalized persons. OBJECTIVE: To evaluate the implementation of a Telemedicine informatics application for nutritional support surveillance of instutionalized persons in nursing homes from a hospital pharmacy service. Method: A multidisciplinary team led by the Hospital Pharmacy Service was created. Data of institutionalized persons in nursing homes needing artificial nutritional support was extracted from the SILICON prescription system and the internal ecords of the hospital pharmacy service. Nursing homes were selected on the basis of their previous experience using the Telemedicine informatics application TELEA. The following nutritional support variables were assessed: score on Mini-Nutritional Assessment questionnaire; a 24-h food record; pressure ulcer control; and laboratory parameters. The existing information flow between nursing homes and hospital specialists was analyzed. The functionalities available on TELEA were considered. RESULTS: In 2021, over 300 institutionalized persons from 28 nursing homes were incluided for nutritional support surveillance program of the hospital pharmacy service. The project was implemented in two nursing homes serving 38 patients, although only 13 were involved in the nutrition surveillance program of the Nutrition Support Unit. Nutritional status assessment and nutritional support surveillance reports were adapted to the Telemedicine informatics application. Paper reports were replaced with electronic data or online questionnaires available on the informatics application. An information flow protocol was established. An instantaneous messaging and alert system was activated, which allowed continuous communication. Some Telepharmacy requests were categorized as preferential when the clinical status of the patient so required. All the information generated during the nutritional status assessment and nutritional support surveillance process was integrated into the electronic medical history of each patient. CONCLUSIONS: TELEA-based nutritional support surveillance facilitates the continuum of care by enabling direct communication between nursing homes and secondary care for institutionalized persons. This model makes it possible to record nutrition-related data on the electronic medical history of patients through a Telepharmacy process. This model also eliminates paper prescriptions and medical reports, and unnecessary travels. A nutritional status profile should also be made available to facilitate nutrition surveillance in institutionalized persons with chronic diseases. That would be the first step for a new integrated healthcare informatics application for frail/polymorbid elderly patients.
Introducción: Los pacientes institucionalizados que requieren soporte nutricional artificial acuden de forma periódica a las consultas de la Unidad de Soporte Nutricional del Servicio de Farmacia. En ellas se realiza una valoración nutricional inicial, a partir de la cual se establece la pauta nutricional y el plan de seguimiento. La Telemedicina y la Telefarmacia se han expandido en los últimos años para la monitorización remota de personas institucionalizadas. OBJETIVO: Evaluar la implementación de una aplicación informática de Telemedicina para la vigilancia del soporte nutricional de personas nstitucionalizadas en residencias de ancianos desde un servicio de farmacia hospitalaria.Método: Se formó un equipo multidisciplinar liderado por el Servicio de Farmacia. Los datos de pacientes institucionalizados que requieren soporte nutricional artificial se obtuvieron del programa SILICON y de los registros internos del Servicio de Farmacia. Se eligieron las primeras residencias candidatas según la experiencia previa en el manejo de la aplicación informática de asistencia domiciliaria. Se analizaron llas variables de soporte nutricional necesarias para el seguimiento nutricional: Mini Nutritional Assessment, recordatorio de ingestas de las últimas 24 horas, control de úlceras por presión y parámetros analíticos. Se analizó el flujo de información existente entre las residencias sociosanitarias y la atención hospitalaria y se valoraron las opciones disponibles a través de la plataforma tecnológica de asistencia domiciliaria. RESULTADOS: El Servicio de Farmacia realizó seguimiento nutricional a más de 300 pacientes institucionalizados en 28 residencias sociosanitarias en el año 2021. El proyecto se implantó en dos residencias sociosanitarias que cuentan con 38 pacientes institucionalizados, aunque solo 13 pacientes estaban en seguimiento por la Unidad de Soporte Nutricional. Todos los registros generados en la valoración y seguimiento nutricional se adecuaron a la aplicación informática de asistencia domiciliaria, se cambiaron los registros en papel por información incluida en la plataforma o cuestionarios online facilitados a través de la misma. Además, se protocolizó el flujo de información generada y se activó un sistema de mensajería con alertas que permite una comunicación continua. En caso de que la situación clínica del paciente lo requiera se puede programar una teleconsulta preferente.Toda la información generada en el proceso de valoración y seguimientonutricional de cada paciente se integró en la historia clínica electrónica. CONCLUSIONES: El seguimiento nutricional a través de la aplicación informática de asistencia domiciliaria facilita la continuidad asistencial por el establecimiento de una comunicación directa entre las residencias sociosanitarias y la atención hospitalaria, permitiendo la integración de la información nutricional de los pacientes en la historia clínica electrónica mediante un proceso de Telefarmacia. Se han eliminado las prescripciones en papel, informes clínicos impresos y los desplazamientos innecesarios. El desarrollo de este perfil podría ser extensible al seguimiento nutricional de pacientes con patologías crónicas, y ser el precedente de un nuevo programa de cuidado integral del paciente anciano frágil o pluripatológico.
Assuntos
Serviço de Farmácia Hospitalar , Telemedicina , Humanos , Idoso , Casas de Saúde , Apoio Nutricional , InformáticaRESUMO
OBJECTIVES: The aim of the study was to assess the direct costs for the Spanish Health System of patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice and to establish possible factors associated with lower costs. METHODS: A descriptive, observational and retrospective study was conducted. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biological therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, disease and biological therapy were included. The annual cost of biological treatment and other direct medical costs were calculated for each disease. The analysis of costs was based on the National Health Service perspective. The time horizon comprised the 8-year long study period. RESULTS: A total of 422 biological therapy lines were analysed. The annual biological therapy cost per patient was 12,494±3,865 for rheumatoid arthritis, 11,248±2,763 for ankylosing spondylitis and 12,263±35,155 for psoriatic arthritis (p=0.008). The cost of biological therapies entailed about 80% of the total cost of these diseases. Hospital admission was a factor which contributed to an increasing cost in all these conditions. A longer duration of the biological therapy was associated with lower cost in all the diseases. CONCLUSIONS: The cost of ankylosing spondylitis is lower than that of rheumatoid arthritis and psoriatic arthritis. The biological therapy is the factor with the highest impact on the overall cost of these diseases. Preventing hospital admissions and a higher persistence to the biological therapy can contribute to lower costs for the system.
Assuntos
Antirreumáticos , Artrite Psoriásica , Espondilite Anquilosante , Antirreumáticos/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Terapia Biológica , Humanos , Estudos Retrospectivos , Espondilite Anquilosante/tratamento farmacológico , Medicina EstatalRESUMO
INTRODUCTION: The aims of the study were to quantify adherence, determine the factors that can predict adherence and identify the consequences of poorer adherence in patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice. METHOD: A descriptive, observational and retrospective study was carried out. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, the disease, the biological therapy and hospital resources were included. Adherence was calculated by using the medication possession ratio. RESULTS: Three hundred and sixty-two patients and 423 lines of biological therapy were included. Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107 (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence interval: 1.1-1.3 [p = 0.001]) and poorer adherence with a failure to attend scheduled appointments at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were no differences between adherent and non-adherent patients in terms of the number of hospital resources used. CONCLUSIONS: There are no differences in adherence to biological therapies among patients with chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient appointments, but this does not imply an increase in the use of hospital resources.
Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1 de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos hospitalarios. La adherencia se calculó mediante la ratio media de posesión.Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ± desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más frecuencia a la consulta del servicio de farmacia(odds ratio de 1,2; intervalo de confianza 95%: 1,1- 1,3 [p = 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]). No hubo diferencias en el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes.Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica un aumento del consumo de recursos.