RESUMEN
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD. METHODS: Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients' home if an alarm signal was detected. The outcomes were compared to historical data from the same patients. RESULTS: The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by 1,860.80 per patient per year. CONCLUSIONS: Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.
Asunto(s)
Costos de la Atención en Salud , Servicios de Atención de Salud a Domicilio/economía , Enfermedad Pulmonar Obstructiva Crónica/terapia , Telemedicina/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/economíaRESUMEN
Objetivo: Realizar una revisión bibliográfica sobre el manejo del estreñimiento para realizar un algoritmo de actuación en la atención a pacientes con enfermedad terminal con estreñimiento. Material y métodos: Revisión sistemática en base de datos UpToDate, PubMed, MD Consult y Cochrane, empleando como palabras clave: constipation, constipation palliative care y management constipation palliative care. Criterios de inclusión: Se incluyeron artículos publicados hasta noviembre de 2010 en español o en inglés, haciendo referencia al estreñimiento en adultos, así como el estreñimiento inducido por opioides. Guías de control de síntomas en cuidados paliativos y manuales, fundamentales en la práctica clínica diaria. Criterios de exclusión: Publicaciones que no sean en inglés o español, artículos generales, estreñimiento en: paciente pediátrico, obstétrico, quirúrgico o casos de enfermedades poco frecuentes. Resultados: Se analizaron 12 artículos y 2 publicaciones. Las pautas de actuación comenzarían desde una correcta valoración del estreñimiento (frecuencia y consistencia de las deposiciones, cambios en el hábito intestinal, la presencia de molestias o dolor con la deposición, la sensación de evacuación completa y la valoración de los factores ambientales). Siempre se pondrán en marcha medidas generales preventivas. Ante el (..) (AU)
Objective: To conduct a literature review on the management of constipation using a performance algorithm in caring for terminally ill patients with constipation. Material and methods: A systematic review Up To Date database, Pub Med, MD Consult and Cochrane, using as keywords: constipation, constipation palliative care and palliative care management. Inclusion criteria: Articles published until November 2010 in Spanish or in English, referring to constipation in adults, including opioid-induced constipation. Guidelines for symptom control in palliative care and manuals fundamental in routine clinical practice. Exclusion criteria: Publications other than English or Spanish, general articles, constipation, in paediatric, obstetrics and surgical patients and rare disease cases. Results: we analysed 12 articles and 2 publications. The course of action should start from an accurate assessment of constipation (frequency and consistency of stools, change in bowel habits, the presence of discomfort or pain with bowel movements, the feeling of complete evacuation and assessment of environmental factors). General preventive measures should always be established. Intestinal obstruction should be ruled (..) (AU)
