[Assessment of a chronic care program in Gerona (CRONIGICAT)]. / Evaluación de un programa de atención a la cronicidad en Girona (CRONIGICAT).

OBJECTIVE: To determine the utility and viability of a chronic care program. DESIGN: Cross-sectional descriptive study with qualitative and quantitative evaluation. SETTING AND PARTICIPANTS: 26 primary care teams (PCT) from the Catalan health service of Gerona. INTERVENTIONS: 20 projects within the program. Start 2011. MAIN OUTCOME MEASURES: The degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]). RESULTS: Evaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. CONCLUSIONS: When assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.

[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]. / Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). PATIENTS AND METHOD: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. CONCLUSIONS: The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Multidisciplinary intervention program for caregivers of patients in a home care program]. / Programa de intervención multidisciplinaria para cuidadores de pacientes en atención domiciliaria.

OBJECTIVES: To improve quality of life, anxiety and depression in caregivers of patients in home care. METHODS: We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made. RESULTS: The intervention group scored significantly better than the control group in relation to WONCA-feelings (p=0.03), WONCA-social activities (p=0.05), and WONCA-quality of life (p=0.02). CONCLUSIONS: A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life.

[Final results of a multifactorial and community intervention study for the prevention of falls in the elderly]. / Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos.

OBJECTIVE: To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the >or=70 years population in a community. DESIGN: Multicentre, community intervention study, with no random assignment and with controls. SETTING: Two basic health areas in the province of Girona (Spain). PARTICIPANTS: Random sample of people >or=70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. MEASUREMENTS AND PRIMARY OUTCOMES: The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. RESULTS: (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8-31.9) and post-intervention 31% (95% CI: 25.6-36.5). CG baseline 32% (95% CI: 28.8-35.2) and post-intervention 30% (95% CI: 24.9-35.4). Falls with fractures: IG baseline 10.4% (95% CI:6-16.3) and post-intervention 5.3% (95% CI:2-11,2); CG baseline 7% (95% CI:4-11.2) and post-intervention 10.7% (95% CI:5.8-17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37-54) and post-intervention 43.8% (95% CI: 34.4-54.4). GC baseline 30.3% (95% CI: 24.3-36.8) and post-intervention 40.8% (95% CI: 31-51.2). CONCLUSIONS: A multifactorial community intervention programme in people >or=70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

Evaluación de un programa de atención a la cronicidad en Girona (CRONIGICAT) / Assessment of a chronic care program in Gerona (CRONIGICAT)

OBJETIVO: Determinar la utilidad y viabilidad del Programa CRONIGICAT. DISEÑO: Estudio descriptivo transversal. Método de evaluación cualitativo y cuantitativo. Emplazamiento y participantes: 26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona. Intervenciones: 20 proyectos dentro del programa. Inicio 2011. Mediciones principales: Grado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad). RESULTADOS: Valoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48 h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado. CONCLUSIONES: Respecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual

OBJETIVO: Determinar la utilidad y viabilidad del Programa CRONIGICAT. DISEÑO: Estudio descriptivo transversal. Método de evaluación cualitativo y cuantitativo. Emplazamiento y participantes: 26 equipos de atención primaria (EAP) del Institut Català de la Salut de Girona. Intervenciones: 20 proyectos dentro del programa. Inicio 2011. Mediciones principales: Grado de desarrollo del programa, indicadores de consenso para la atención a la cronicidad y IEMAC (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad). RESULTADOS: Valoración del grado de desarrollo: 75% de proyectos implementados parcial o totalmente, con un desarrollo alto en 71% de los EAP. Tendencia a aumentar los indicadores de consenso del proceso (pacientes contactados 48 h tras el alta hospitalaria, población atendida en programas de atención a la cronicidad y con estratificación de riesgo más alto). Ligero descenso interanual de los indicadores de consenso de efectividad (reingresos, estancia media hospitalaria, hospitalizaciones evitables, gasto farmacéutico, pacientes atendidos en urgencias y mortalidad). Dimensiones mejor puntuadas del IEMAC las que evalúan los sistemas de información y el apoyo en la toma de decisiones clínicas y las peor puntuadas son la salud comunitaria y el autocuidado. CONCLUSIONES: Respecto a la utilidad del CRONIGICAT, consideramos que existe un avance principalmente a nivel de su implantación, actuando como catalizador para el cambio autodirigido a un mejor modelo de atención a la cronicidad y identificando aspectos de mejora. Creemos que es viable y sostenible al estar sus acciones y proyectos integrados dentro de la actividad asistencial habitual

Programa de intervención multidisciplinaria para cuidadores de pacientes en atención domiciliaria / Multidisciplinary intervention program for caregivers of patients in a home care program

Objetivos: Mejorar la calidad de vida, la ansiedad y la depresiónde los cuidadores de pacientes en atención domiciliaria.Métodos: Ensayo clínico aleatorizado; 79 cuidadores principales(39 grupo control y 40 grupo intervención) de pacientesen atención domiciliaria de un centro de salud entre 2000 y2001. La calidad de vida, la ansiedad y la depresión se midieronmediante los cuestionarios COOP/WONCA y la escalade Goldberg, respectivamente, al inicio y al final del estudio.Las intervenciones consistieron en 2 visitas médicas pararealizar la anamnesis biopsicosocial del cuidador y una visitade enfermería sobre educación sanitaria. Se enviaron doscartas adaptadas a cada cuidador y se realizaron dos llamadastelefónicas de apoyo.Resultados: Se observó una mejora significativa del grupointervención respecto al grupo control en relación conWONCA-sentimientos (p = 0,03), WONCA-actividades sociales(p = 0,05) y WONCA-calidad de vida (p = 0,02).Conclusiones: Una intervención multidisciplinaria y adaptadaa la consulta habitual podría reducir el deterioro de la calidadde vida de los cuidadores(AU)

Objectives: To improve quality of life, anxiety and depressionin caregivers of patients in home care.Methods: We performed a randomized clinical trial in 79 maincaregivers (39 control group and 40 intervention group) of patientsin the home care program of a primary care health centerbetween 2000 and 2001. Quality of life, anxiety and depressionwere measured by the COOP/WONCA and Goldbergquestionnaires, respectively, at the beginning and at the endof the study. Interventions consisted of two medical visits totake a bio-psychosocial history of the caregiver and a nursevisit for health education. Two letters, adapted to each carer’sneeds, were sent and two telephone calls were made.Results: The intervention group scored significantly betterthan the control group in relation to WONCA-feelings (p = 0.03),WONCA-social activities (p = 0.05), and WONCA-quality oflife (p = 0.02).Conclusions: A short multidisciplinary intervention programadapted to routine consultations could prevent deteriorationin caregivers’ quality of life(AU)

Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos / Final results of a multifactorial and community intervention study for the prevention of falls in the elderly

Objetivo Evaluar la efectividad de un programa de intervención multifactorial y comunitario para disminuir el número de caídas y sus complicaciones en la población de 70 años o más de una comunidad. Diseño Estudio de intervención comunitaria, multicéntrico, con grupo control y sin asignación aleatorizada. Emplazamiento Dos zonas básicas de salud de la provincia de Girona (España). Participantes Muestra aleatorizada de personas 70 años o más, 2.515 en el grupo de intervención (GI) y 1.212 en el grupo control (GC). Participantes El GI recibió una intervención multifactorial con actividades comunitarias, individuales en la consulta o domicilio y sobre los profesionales durante 2 años. El GC recibió la atención sanitaria habitual. Mediciones y resultados principales Se valoró la situación basal de 2 muestras aleatorizadas representativas, GI (n=329) y GC (n=379), y la situación posintervención del GI (n=292) y el GC (n=310) mediante una encuesta. Personas con caídas GI basal, el 29% (intervalo de confianza [IC] del 95%: 25,8–31,9) y posintervención, el 31% (IC del 95%: 25,6–36,5); GC basal, el 32% (IC del 95%: 28,8–35,2) y posintervención, el 30% (IC del 95%: 24,9–35,4). Caídas con fracturas: GI basal, el 10,4% (IC del 95%: 6–16,3) y posintervención, el 5,3% (IC del 95%: 2–11,2); GC basal, el 7% (IC del 95%: 4–11,2) y posintervención, el 10,7% (IC del 95%: 5,8–17,7). Caídas con asistencia médica: GI basal, el 45,4% (IC del 95%: 37–54) y posintervención, el 43,8% (IC del 95%: 34,4–54,4); GC basal, el 30,3% (IC del 95%: 24,3–36,8) y posintervención, el 40,8% (IC del 95%: 31–51,2). Conclusiones n programa de intervención comunitario multifactorial en personas de 70 años o más no reduce el número de caídas a los 2 años, pero se observa una tendencia a la reducción de sus consecuencias y puede integrarse dentro de la actividad asistencial habitual (AU)

Objective To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the >=70 years population in a community. Design Multicentre, community intervention study, with no random assignment and with controls. Setting Two basic health areas in the province of Girona (Spain). Participants Random sample of people >=70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). Participants The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. Measurements and primary outcomes The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. Results (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8–31.9) and post-intervention 31% (95% CI: 25.6–36.5). CG baseline 32% (95% CI: 28.8–35.2) and post-intervention 30% (95% CI: 24.9–35.4). Falls with fractures: IG baseline 10.4% (95% CI:6–16.3) and post-intervention 5.3% (95% CI:2–11,2); CG baseline 7% (95% CI:4–11.2) and post-intervention 10.7% (95% CI:5.8–17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37–54) and post-intervention 43.8% (95% CI: 34.4–54.4). GC baseline 30.3% (95% CI: 24.3–36.8) and post-intervention 40.8% (95% CI: 31–51.2). Conclusions A multifactorial community intervention programme in people >=70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities(AU)