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1.
Aten Primaria ; 46(6): 298-306, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24768654

RESUMO

OBJECTIVE: Examine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia. DESIGN: Cross-sectional study using a survey. PARTICIPANTS: Three hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010. MEASUREMENTS: Survey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants. MAIN RESULTS: Response rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals.>50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record.>50% recognized a high priority strategies for improving the quality. CONCLUSION: Despite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.


Assuntos
Atenção Primária à Saúde , Espirometria/estatística & dados numéricos , Estudos Transversais , Humanos , Espanha , Inquéritos e Questionários
2.
Rev Esp Salud Publica ; 90: e1-e16, 2016 Jul 07.
Artigo em Espanhol | MEDLINE | ID: mdl-27382930

RESUMO

The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit.


El objetivo del trabajo fue desarrollar un marco conceptual para la evaluación de nuevos programas de gestión clínica y asistencial de carácter integrado en el Sistema Nacional de Salud para la atención a las personas con enfermedades crónicas. Se realizó una revisión exhaustiva de la literatura entre 2002-2013 incluyendo revisiones sistemáticas, metaanálisis e informes con modelos de evaluación y/o evaluaciones de programas. Se estudiaron y describieron programas locales de atención a la cronicidad implementados en Cataluña y se realizaron entrevistas semiestructuradas con expertos clave en el ámbito catalán. El alcance y el marco conceptual se definieron mediante la técnica del brainstorming. De 910 resúmenes identificados, se incluyeron 116 documentos que se referían a marcos conceptuales e indicadores de evaluación a nivel español e internacional. Se identificaron 24 programas de atención a la cronicidad (9 de carácter integrado). El marco conceptual propuesto contempló: 1) la población diana según niveles de complejidad; 2) un enfoque de evaluación de la estructura, procesos y resultados teniendo en cuenta el estado de salud conseguido, el proceso de recuperación y mantenimiento de la salud; y 3) las dimensiones o atributos que se deben evaluar. El marco conceptual propuesto permite desarrollar indicadores e implementarlos con un enfoque comunitario, orientados a los resultados y tener una visión territorial o poblacional, que será imprescindible para saber cuál es la estrategia más efectiva, cuáles son los elementos que determinan un mayor éxito y cuáles son los grupos de pacientes que más se pueden beneficiar.


Assuntos
Doença Crônica/terapia , Prestação Integrada de Cuidados de Saúde/normas , Atenção à Saúde/normas , Programas Nacionais de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Humanos , Espanha
3.
Arch Bronconeumol ; 51(10): 483-9, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25447590

RESUMO

UNLABELLED: Hospitalizations for acute exacerbation of COPD (AECOPD) generate high consumption of health resources, frequent readmissions and high mortality. The MAG -1 study aims to identify critical points to improve the care process of severe AECOPD requiring hospitalization. METHODS: Observational study, with review of clinical records of patients admitted to hospitals of the Catalan public network for AECOPD. The centers were classified into 3 groups according to the number of discharges/year. Demographic and descriptive data of the previous year, pharmacological treatment, care during hospitalization and discharge process and follow-up, mortality and readmission at 30 and 90 days were analyzed. RESULTS: A total of 910 patients (83% male) with a mean age of 74.3 (+10.1) years and a response rate of 70% were included. Smoking habit was determined in only 45% of cases, of which 9% were active smokers. In 31% of cases, no previous lung function data were available. Median hospital stay was 7 days (IQR 4-10), increasing according the complexity of the hospital. Mortality from admission to 90 days was 12.4% with a readmission rate of 49%. An inverse relationship between length of hospital stay and readmission within 90 days was observed. CONCLUSIONS: In a large number of medical records, smoking habit and lung function tests were not appropriately reported. Average hospital stay increases with the complexity of the hospital, but longer stays appear to be associated with lower mortality at follow-up.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Testes Diagnósticos de Rotina/estatística & dados numéricos , Progressão da Doença , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Volume Expiratório Forçado , Departamentos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Registros Hospitalares , Hospitalização , Humanos , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Ventilação não Invasiva/estatística & dados numéricos , Oxigênio/sangue , Oxigenoterapia/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Fumar/epidemiologia , Espanha/epidemiologia , Resultado do Tratamento
4.
Arch Bronconeumol ; 51(10): 490-5, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25618455

RESUMO

INTRODUCTION: Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data. METHODS: Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors. RESULTS: A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001). CONCLUSIONS: High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment.


Assuntos
Serviços de Assistência Domiciliar/estatística & dados numéricos , Prescrições , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Mineração de Dados , Feminino , Acessibilidade aos Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Unidades Hospitalares , Humanos , Masculino , Serviço Hospitalar de Registros Médicos/organização & administração , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Oxigenoterapia/instrumentação , Distribuição de Poisson , Prescrições/estatística & dados numéricos , Pneumologia/organização & administração , Terapia Respiratória/estatística & dados numéricos , Espanha
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