Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi.

BACKGROUND AND OBJECTIVES: The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique. METHODS: The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts. RESULTS: Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care. CONCLUSIONS: The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.

Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review.

eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. OBJECTIVE: Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. METHOD: An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. RESULTS: Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. CONCLUSIONS: eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.

Consejería personalizada en salud en personas con enfermedades crónicas / Personalized health counseling for people with chronic diseases

La Consejería Personalizada en Salud es considerada una herramienta de ayuda para propiciar cambios especialmente relacionados con estilos de vida. Objetivo: Describir las bases teóricas de la consejería y su aplicación en la práctica clínica. Se identifican los objetivos, las etapas y la metodología de trabajo de la consejería. La Consejería Personalizada en Salud es una herramienta inherente al conocimiento y crecimiento personal, para tratar cambios en salud sobre todo en enfermedades de tipo crónico no transmisible. (AU)

Personalized Health Counseling is considered a helpful tool to promote changes especially related to lifestyles. Objective: Describes the theoretical bases of counseling, and its application in clinical practice. The objectives, stages, and work methodology of the counseling are identified. Personalized Health Counseling is a tool inherent to knowledge and personal growth, to treat changes in health, especially in non-communicable chronic diseases. (AU)

Perfil de usuarios con diabetes e hipertensión arterial y su relación con indicadores de resultado clínicos / Diabetes and hypertension; how user profile relates to indicators of clinical outcomes

Resumen: Objetivo: Describir el perfil de usuarios con diabetes mellitus (DM) e hipertensión arterial (HTA) y su relación con indicadores de resultado clínico. Sujetos y métodos: Estudio transversal, correlacional en usuarios con DM y/o HTA, reclutados desde 4 centros de salud de un Servicio de Salud del centro sur de Chile. Los instrumentos y mediciones incluyeron: cuestionario de variables biodemográficas, "Evaluación de la atención de enfermedades crónicas para pacientes", hemoglobina glicosilada (HbA1c), presión arterial sistólica (PAS) y diastólica (PAD). Resultados: Se evaluaron 222 personas con HTA y/o DM con edad promedio 53,9 (DE 7,5) años, la mayoría mujeres (67,6%). Se encontró un predominio de HTA (53,6%), seguido de DM+HTA (31,1%) y DM (15.3%). El promedio de PAS y de HbA1c fue levemente superior en usuarios con patología mixta (DM+HTA). El promedio de la evaluación de la atención desde la perspectiva del paciente fue 2,61 (DE 1,13), siendo mejor evaluado el "Diseño de un sistema de entrega de cuidados/Apoyo a la decisión". Se encontró relación significativa en usuarios con HTA entre PAS y n° de fármacos (p=0,026); en personas con DM entre HbA1c y años de enfermedad (p=0,002) y en usuarios con multimorbilidad (HTA+ DM) entre años de enfermedad con HbA1c (p=0,01) y con PAS (p=0,01). Conclusión: La evaluación de la atención sugiere la necesidad de mayor esfuerzo en el control de los parámetros terapéuticos, incorporando mejoras en la atención proporcionada. Se necesita más investigación para definir la relación entre el perfil de usuarios con enfermedades crónicas y los resultados clínicos.

Abstracts: Aim: To decribe the profile of users of a health program for chronic diseases (CD), especifically Diabetes Mellitus (DM) and Hypertension (HT), and its relation to indicators of clinical results. Subjects and methods: The subjects had DM and/or HT and were randomly selected form 4 health centers in southern Chile. Questionaires exploring demographic variables, Patient Assessement of Chronic Illness Care (PACIC) measurements of HbA1c, systolic (SBP) and diastolic (DBP) pressures were used as indicators of clinical results. Results: 222 subjects with DM and/or HT were evaluated. Mean age was 53.9 years-old (SD 7.5), 67.6% were females. The prevalence of CD was 53.6% for HT, 31.1% for DM+HT and 15.3% for DM. Mean BP and mean HbA1c were slightly higher in users with DM+HT. As perceived by the patient, the evaluation of care had a mean score 2.61 (SD 1.13). "Design of a method of care delivery / decission support" obtained the highest score. In subjects with HT there was a significant correlation between SBP and the number of drugs being received (p=0.03). Also, a significant correlation between HbA1c and disease duration was found in subjects with DM (p=0.02). In subjects with DM+HT significant correlation (p=0.01) existed between disease duration and both HbA1c and SBP. Conclusion: The evaluation of care suggests the need for a stronger effort in controlling therapeutic measures. Further studies are needed to refine the relation of user profile and clinical results.

The Comfort Theory as a Theoretical Framework Applied to a Clinical Case of Hospital at Home.

The comfort theory was applied in the development of a nursing process for the clinical case of an older adult with pneumonia treated under hospital at home. It was observed that the theory is easy to apply in the domiciliary context and that it allows the implementation of a holistic care plan.

Indicadores de calidad de la atención en salud en hospitalización domiciliaria: revisión integradora / Indicators of the Quality of Health Care in Home Hospitalization: An Integrative Review / Indicadores de qualidade da atenção em saúde na hospitalização domiciliar: revisão integrativa

RESUMEN Objetivo: describir la producción empírica sobre indicadores para evaluar la calidad de la atención en salud otorgada a usuarios de unidades de hospitalización domiciliaria (HD). Materiales y métodos: se realizó una revisión integradora en las bases Pubmed, Web of Science, IBECS, SciELO y Biblioteca Cochrane. El periodo de búsqueda se extendió del año 1990 hasta el 2017. Resultados: se hallaron 10 documentos, de los cuales 6 correspondieron a artículos originales y 4 a revisiones sistemáticas. Solo en 3 de los 6 artículos originales hallados se mencionaron indicadores relacionados con reingresos hospitalarios no planificados, llamadas telefónicas no planificadas realizadas por los pacientes y/o el equipo de salud de HD, negativa de los pacientes a ser ingresados a HD y errores en la administración de medicamentos. Conclusión: la investigación de la evaluación de la calidad de la atención en salud en HD mediante indicadores ha tenido un escaso desarrollo, especialmente en enfermería. Los indicadores pesquisados han sido desarrollados solo en algunos países europeos, pero sin reportar bases conceptuales claras y sin asegurar la solidez científica y factibilidad de las medidas.

ABSTRACT Objective: Describe the empirical production of indicators to evaluate the quality of health care provided to users of home hospitalization units (HH). Materials and methods: An integrative review was conducted using the Pubmed, Web of Science, IBECS, SciELO and the Cochrane Library databases. The search period went from 1990 to 2017. Results: Ten (10) documents were found: six original articles and four systematic reviews. Only three of the six original articles in question mention indicators related to unplanned hospital readmissions, unplanned telephone calls made by patients and / or the HH health team, refusal of patients to be admitted to HH, and errors in the administration of medication. Conclusion: Research on evaluation of the quality of health care in HH using indicators is very limited, especially in the field of nursing. The researched indicators were developed only in several European countries, but with no clear conceptual basis and without ensuring the scientific soundness and feasibility of the measurements.

RESUMO Objetivo: descrever a produção empírica sobre indicadores para avaliar a qualidade da atenção em saúde outorgada a usuários de unidades de hospitalização domiciliar (HD). Materiais e método: realizou-se uma revisão integrativa nas bases PubMed, Web of Science, IBECS, SciELO e Biblioteca Cochrane. O período de busca foi de 1990 a 2017. Resultados: foram encontrados 10 documentos, dos quais 6 corresponderam a artigos originais e 4 a revisões sistemáticas. Somente em 3 dos 6 artigos originais, mencionaram-se indicadores relacionados com reinternação hospitalar não planejada, ligações não esperadas pelos pacientes e/ou pela equipe de saúde de HD, negativa dos pacientes a serem inseridos na HD e erros na administração de medicamentos. Conclusão: a pesquisa da avaliação da qualidade da atenção em saúde em HD, mediante indicadores, tem tido pouco desenvolvimento, especialmente em enfermagem. Os indicadores pesquisados foram desenvolvidos somente em alguns países europeus, mas sem relatar bases conceituais claras e sem garantir a solidez científica e factibilidade das medidas.

Evaluación de la atención a usuarios con enfermedad crónica cardiovascular en Centros de Salud Familiar / Evaluation of care provided to users suffering from chronic cardiovascular disease at Family Health Centers

Antecedentes: El control de las enfermedades cardiovasculares es un reto para los sistemas de salud. Objetivo: Determinar si la atención proporcionada por los equipos de salud a usuarios/as con enfermedades cardiovasculares crónicas es congruente con el Modelo de Cuidados Crónicos y explorar su efectividad a través de indicadores de compensación del programa de salud cardiovascular. Métodos: Se empleó un diseño descriptivo, transversal. Participaron los equipos de salud (9) que otorgan atención a usuarios crónicos (diabéticos e hipertensos) en Centros de Salud Familiar de un Servicio de Salud del Centro Sur de Chile. Se utilizó el instrumento "Evaluación de la atención de enfermedades crónicas" (ACIC) versión 3.5 adaptada al castellano Chileno. Se analizaron los Indicadores de compensación para hipertensión arterial y diabetes mellitus tipo 2 del programa cardiovascular obtenidos del Resumen Estadístico Mensual de cada centro de salud. Resultados: La atención otorgada a usuarios/as con enfermedad crónica fue evaluada como apoyo básico a las enfermedades crónicas. La sección mejor evaluada fue "Organización del Sistema de atención de salud". Las dimensiones con puntajes más bajos fueron "Integración de los componentes del modelo" y "Apoyo a la toma de decisiones". Se observó solo una tendencia a correlación positiva entre la evaluación de la atención otorgada a usuarios/as y los indicadores de compensación para diabetes mellitus tipo 2, no así para hipertensión. Conclusión: La "Organización del Sistema de atención de salud" fue la sección mejor evaluada del Modelo de Cuidados Crónicos en 9 Centros de Atención Familiar. No se encontró relación estadísticamente significativa con los indicadores de compensación para diabetes mellitus tipo 2 e hipertensión arterial.

Background: Control of cardiovascular disease remains a challenge for health care systems. Objective: To determine whether care provided by health teams to users suffering from chronic cardiovascular diseases is consistent with the Chronic Care Model, and to explore it's effectiveness using compensation indicator from the cardiovascular health programs. Methods: A descriptive cross-sectional design was used. 9 health teams providing assistance to chronic users (diabetes and hypertension) in Family Health Centers in southern-central Chile were included. We used ACIC version 3.5 adapted to Chilean Spanish to evaluate quality of chronic care. Indicators of compensation for hypertension and diabetes mellitus type 2 defined by national cardiovascular programs were obtained from the monthly statistical summary of each health center. Results: "Organization of the Healthcare Delivery System" was the best evaluated dimension. The lower scores corresponded to "Integration of Chronic Care Model Components" and "Decision Support". Only a tendency for a positive correlation wasfound between care given to users suffering from chronic disease and compensation indicators for type 2 diabetes mellitus. No such tendency was observed for hypertension. Conclusion: "Organization of the Healthcare Delivery System" was the best evaluated dimension of the Chronic Care Model in 9 Health temas delivering care to chronic users in Chile The relation between chronic care dimensions and compensation indicators for type 2 diabetes mellitus and hypertension was not satisfactory.

Efecto de intervención innovadora: consejería de enfermería en salud cardiovascular en atención primaria / Effect of an innovative process of nursing counseling on cardiovascular health in a primary health care setting

Antecedentes: La prevención de enfermedades cardiovasculares es un reto para los sistemas de salud. Objetivo: Establecer el efecto de una intervención innovadora de Consejería de Enfermería Personalizada, Presencial y Telefónica, dirigida a: control de factores de riesgo cardiovascular (hipertensión, dis-lipidemia, sobrepeso), mejoramiento de calidad de vida relacionada con salud (CVRS), fortaleciendo la autoeficacia, el apoyo social y estructurando el fenómeno "vivir con expectativas de cambio" en personas usuarias del programa de salud cardiovascular de los Centros de Salud Municipales de Concepción. Método: Se usó método mixto anidado, como método primario el cuantitativo, ensayo clínico controlado aleatorizado. Se randomizaron controles (n=56) e intervenidos (n=53) sometidos a 10 sesiones presenciales y 5 telefónicas. Se midió CVRS, presión arterial, IMC, circunferencia abdominal, colesterol total, LDL, HDL, LDL/HDL), CT/HDL y Riesgo Coronario a 10 años. El método secundario cualitativo fue el de Parse. fenomenológico-hermenéutico. Resultados: mujeres y hombres disminuyeron circunferencia abdominal, colesterol total, colesterol-LDL, CT/HDL (p<0,05); las mujeres disminuyeron significativamente peso y aumentaron CVRS. Los hombres disminuyeron presión arterial sistólica y diastólica, LDL/HDL, y riesgo coronario a 10 años. En lo cualitativo se estructura "vivir con expectativas de cambio", como un proceso interactivo de cuidado que integran lo físico y psicológico, el cual establece alianzas que generan compromisos personales y contribuyen a enfrentar las dificultades con perseverancia y con acciones innovadoras. Conclusiones: Esta intervención es una estrategia efectiva para el control de tres factores de riesgo cardiovascular y mejoramiento de CVRS.

Background: prevention of cardiovascular disease remains a challenge for health care systems Aim: to evaluate the effect of an innovative process of personalized nursing counseling including telephone monitoring on cardiovascular risk factors and quality of life indexes. Method: the intervention took place at municipal health care facilities involved in the program for cardiovascular health in Concepción, Chile. After randomization, 56 subjects acted as controls and 53 were submitted to 10 personalized and 5 telephone counseling sessions. Variables measured included CVRS, blood pressure, pressure, BMI, abdominal circumference, total, LDL and HDL cholesterol levees and derived risk indexes. Coronary risk at 10 years was estimated. A parallel qualitative evaluation was performed through a phenomenological-hermeneutic method. Results: abdominal circumference, total and LDL cholesterol and Chol/HDL ratio decreased in both males and females. Weight decreased and CVRS increased in females. Systolic and diastolic blood pressure, LDL/HDL ratio and 8-year risk of CVD decreased in males. Qualitative intervention was effective in developing an attitude of "living with an expectation of change" and in creating personal interactions to strengthen such attitude. Conclusion: this innovative health intervention strategy was effective in the control of three cardiovascular risk factors and in improving CVRS.

[Job performance and climacteric in female workers]. / Desempeño laboral y climaterio en trabajadoras de instituciones públicas.

BACKGROUND: During climacteric, the presence of disabling symptoms and the higher incidence of chronic diseases, may impair the job performance of women. AIM: To relate job performance levels with the climacteric period and associated factors in working women aged from 42 to 55 years old. SUBJECTS AND METHODS: In a cross-sectional and correlative design, 64 secretaries at two public organizations at the Eighth Region of Chile, were assessed using the following instruments: Menopause-Specific Quality of Life Questionnaire (University of Toronto), adapted for Chile by PROSAM, Climacteric Self-care Questionnaire, Perceived Social Support Scale and Biodemographics Variables Questionnaire. A Perception of the Job Performance Scale was applied to the persons that superintended these woman. RESULTS: The Department Heads or persons supervising these women, determined that most workers did their work well. The best evaluations were given by older bosses. Most women under study showed a moderate alteration of the Menopause Quality of Life. A deficit of self-care during the climacteric period was detected in 92.2%. The perceived social support from friends correlated with job performance. Menopause quality of life in its different domains had no correlation with job performance variable. CONCLUSIONS: No association between changes during the climacteric period and job performance was observed among women participating in this study.

El climaterio: algunos aspéctos biosociales y su manejo terapéutico a nivel primario / Climateric: some biosocial aspects and it therapeutic management at primary level

Estudio descriptivo prospectivo en que se analizan las variables: edad, trastornos neurovegetativos y manifestaciones psicológicas más frecuentes; alteraciones de la dinámica familiar; porcentaje de mujeres que consultan a nivel primario y reciben tratamiento hormonal, de 82 mujeres seleccionadas accidentalmente sin patología crónica, durante el período comprendido entre el 23 de Noviembre y el 16 de Diciembre de 1994, en tres consultorios urbanos de Valparaíso: Plaza Justicia, Hospital de Niños y Barón. Al finalizar nuestro estudio podemos concluir que el mayor porcentaje de mujeres climatéricas se encuentra en el rango de edad de 45-49 años (33 porciento). El trastorno neurovegetativo más frecuente es el bochorno (83 porciento), sintomatología típica del climaterio, ocasionado por el desajuste hormonal, sin embargo, hay que destacar la cefalea en un porcentaje similar ( 82 porciento), pero dicho síntoma es multicausal, muchas veces de carácter subjetivo. La manifestación psicológica más frecuente que presenta la mujer climatérica es la irritabilidad (73 porciento), sin embargo es muy significativo el porcentaje de riesgo de depresión (70 porciento). La dinámica familiar no presenta alteración (60 porciento). En cuanto al porcentaje de mujeres que consultan a nivel primario es bajo ( 25 porciento) y el de las que la reciben tratamiento hormonal a nivel primario, es aún más bajo: sólo con un 4 porciento. Hay que destacar que hay un 19 porciento de las mujeres, que consultan médico particular y que la mayoría, un 16 porciento, reciben tratamiento hormonal