Relationship between Falls and the Use of Medications and Diseases in an Otago Exercise Programme in Old People Living in the Community in Spain.

(1) Background: Falls are a significant health problem among older adults, and can result in severe injuries, disability, and even death. In Spain, the prevalence of falls is lower if the person lives in the community than if they are institutionalized. Research has shown that exercise is an effective strategy for reducing the risk of falls among older adults. The objective of this study was to study the influence of a multicomponent exercise intervention on falls in people between 65 and 80 years of age despite the presence of diseases and drug use that are risk factors for falls; (2) Methods: This is a quasi-experimental study that focuses on people aged 65-80 who attended 21 primary healthcare centres. Target: Inclusion criteria were people between 65 and 80 years of age, living in the community with independent ambulation, and who were served by the healthcare centre of their region. Variables analysed: The number and characteristics of falls, sociodemographic, drug use, and previous diseases; (3) Results: The drugs associated with falls are benzodiazepines (OR 2.58), vasodilators (OR = 2.51), and psychotropics (OR = 1.61). For one of the years, a relationship was found between the consumption of antidepressants and falls (OR = 1.83). The associated diseases were mental and behavioural (OR = 2.53); (4) Discussion: The intervention has been related to the reduction in falls in people who consumed benzodiazepines, vasodilators, and psychotropics and in people with mental disorders; (5) Conclusion: This research concludes the importance of the implementation of the Otago Exercise Programme in the prevention of falls in the elderly.

Variability in Healthcare Expenditure According to the Stratification of Adjusted Morbidity Groups in the Canary Islands (Spain).

Morbidity is the main item in the distribution of expenditure on healthcare services. The Adjusted Morbidity Group (AMG) measures comorbidity and complexity and classifies the patient into mutually exclusive clinical categories. The aim of this study is to analyse the variability of healthcare expenditure on users with similar scores classified by the AMG. Observational analytical and retrospective study. Population: 1,691,075 subjects, from Canary Islands (Spain), aged over 15 years with data from health cards, clinical history, Basic Minimum Specialised Healthcare Data Set, AMG, hospital agreements information system and Electronic Prescriptions. A descriptive, bivariant (ANOVA coefficient η2) and multivariant analysis was conducted. There is a correlation between the costs and the weight of AMG (rho = 0.678) and the prescribed active ingredients (rho = 0.689), which is smaller with age and does not exist with the other variables. As for the influence of the AMG morbidity group on the total costs of the patient, the coefficient η2 (0.09) obtains a median effect in terms of the variability of expenditure, hence there is intra- and inter-group variability in the cost. In a first model created with all the variables and the cost, an explanatory power of 36.43% (R2 = 0.3643) was obtained; a second model that uses solely active ingredients, AMG weight, being female and a pensioner obtained an explanatory power of 36.4%. There is room for improvement in terms of predicting the expenditure.

[Limited Reuse and Extended Use of Filtering Facepiece Respirators]. / Reutilización limitada y uso extendido de mascarillas de media-alta filtración.

AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like COVID-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: Scoping review. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: The reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model.

[Nurses in the approach to frailty. Reflective analysis on the importance of nursing care in frail elderly.] / Profesionales de enfermería en el abordaje de la fragilidad. Análisis reflexivo sobre la importancia de los cuidados en la atención a la persona mayor frágil.

At present, the definition of frailty provided by the World Health Organization (WHO), which incorporates the concepts of intrinsic capacity and functional capacity, as well as the increasing prevalence of these situations in elderly people, reflect the need to develop intervention strategies in the different health systems to prevent and address frailty. This article analyzes the implication of the nursing role, as well as its framework of action and specific competencies for the prevention and addressing of the health needs related to the frail elderly person.This role is developed through the systematic use of comprehensive assessment, existence of nursing diagnoses related to frailty and its risks and the interventions and outcome criteria related to the care of the frail elderly person. Specifically, this article expose the actions and competences of nurses who carry out their activity in primary care and in the community context, in care programs for the elderly and home care, which involve both the frail elderly person and the people who care for them.

En la actualidad, una mayor unanimidad con la definición de la fragilidad, aportada por la Organización Mundial de la Salud (OMS), que incorporan los conceptos de capacidad intrínseca (CI) y capacidad funcional (CF), así como la cada vez mayor prevalencia de estas situaciones en la población mayor, reflejan la necesidad de desarrollar estrategias de intervención en los diferentes sistemas sanitarios para prevenir y abordar la fragilidad. En este artículo se analiza la implicación del rol del enfermero, así como su marco de actuación y competencias específicas para la prevención y abordaje de las necesidades y problemas de salud relacionados con la persona mayor frágil, a través del uso sistemático de la valoración integral, la existencia de diagnósticos enfermeros relativos a la fragilidad y sus riesgos y de las intervenciones y criterios de resultados vinculados a los cuidados de la persona mayor frágil. Especialmente, se exponen las actuaciones y competencias de los enfermeros que desarrollan su actividad en atención primaria y el contexto comunitario, en los programas de atención al mayor y atención domiciliaria, que implican tanto a la persona mayor frágil como a las personas que los cuidan.

The Relation between Functional Performance, Falls and Previous Falls Among Participants in the Otago Programme: A Secondary Data Analysis.

Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.

Reutilización limitada y uso extendido de mascarillas de media-alta filtración / Limited Reuse and Extended Use of Filtering Facepiece Respirators

OBJETIVO: Los equipos de protección individual (EPI), y dentro de ellos las mascarillas, son fundamentales en una pandemia como la del Covid-19, que ha requerido, en muchas ocasiones, de reutilización de material debido a su escasez. El objetivo de esta revisión es sintetizar la evidencia disponible sobre la reutilización y uso extendido de las mascarillas de media y alta filtración. MÉTODO: revisión exploratoria. Búsqueda a través de lenguaje natural en PUBMED y Centros, Agencias y Organizaciones para el Control de Enfermedades. Se limitó a artículos publicados entre 2010-2020 en inglés y español. RESULTADOS: se localizaron 83 artículos, seleccionándose 14, más 5 recomendaciones. Los temas abordados se clasifican en 7 apartados: caducidad, uso extendido y reutilización de mascarillas, técnica de manipulación, sellado, efectos físicos psicológicos y cumplimentación, contaminación y descontaminación de mascarillas. CONCLUSIONES: la reutilización de las mascarillas no está recomendada por los organismos oficiales ni los fabricantes, sólo se acepta en casos extraordinarios, como las pandemias. Los estudios se caracterizan por contar con muestras pequeñas, usan diferentes modelos de mascarillas ajustando su recomendación al modelo

AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like Covid-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: scopingre view. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: the reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model

Enfermería de Práctica Avanzada y gestión de casos: elementos imprescindibles en el nuevo modelo de atención a la cronicidad compleja en España / Advanced practice in case management: An essential element in the new complex chronicity care model

El aumento de la prevalencia de enfermedades crónicas complejas en todas las etapas de la vida; el progresivo envejecimiento de la población; la prevalencia de multimorbilidad, la polimedicación, y la pérdida de autonomía, han hecho emerger nuevas necesidades en la sociedad, a las que el actual modelo de atención no está dando respuestas eficaces ni sostenibles. Las personas con enfermedades crónicas complejas son vulnerables, se van deteriorando a medida que las enfermedades progresan, y requieren cuidados profesionales individualizados y coordinados, que tengan en cuenta la progresión de la enfermedad, las transiciones y las preferencias de las personas. Es imprescindible determinar un nuevo paradigma de atención en el que enmarquemos los proyectos y las acciones que se deben impulsar para avanzar hacia una atención transversal, de calidad y sostenible dirigida a las personas con enfermedades crónicas complejas y avanzadas en todas las etapas de la vida. Diferentes estudios demuestran que la gestión de casos es un valor añadido en términos de calidad, seguridad y coste-efectividad. Sin embargo, su implementación en España es desigual y heterogénea, no habiéndose desarrollado aún normativa alguna que dé estabilidad a esta nueva figura enfermera. El Ministerio y las Comunidades Autónomas, tienen ahora la responsabilidad de crear normativa e institucionalizar la figura de enfermera gestora de casos como modelo de práctica avanzada, con una definición clara de sus competencias y funciones, tal y como se ha hecho en otros países

The increased prevalence of complex chronic diseases in all stages of life, the progressive aging of the population, the prevalence of multimorbidity, polypharmacy, and loss of autonomy, have given rise to new needs in society. The current model of care is failing to meet these needs in an effective or sustainable way. People with complex chronic diseases are vulnerable, they deteriorate as diseases progress, and they require individualized and coordinated professional care that takes into account the progression of the disease, transitions and people's preferences. It is essential to determine a new care paradigm as a framework for the projects and actions that should be promoted to reach transversal, sustainable and quality care directed at people with complex and advanced chronic diseases in all stages of life. Different studies show that case management is an added value in terms of quality, safety and cost-effectiveness. However, its implementation in Spain is uneven and heterogeneous, and no regulations have yet been developed to give stability to this new nurse figure. The Ministry and the Autonomous Communities now have the responsibility to create regulations and institutionalize the figure of case management nurses/advanced practice nurses, with a clear definition of their professional competences and functions, as has been done in other countries

Comparación de modelos predictivos para la selección de pacientes de alta complejidad / Comparison of predictive models for the selection of high-complexity patients

Objetivo: Comparar la concordancia de los pesos de complejidad entre los estratificadores Clinical Risk Groups (CRG) y los grupos de morbilidad ajustada (GMA), determinar cuál de ellos es el mejor predictor de ingreso hospitalario y optimizar el método para seleccionar el 0,5% de pacientes de más alta complejidad que se incluirán en un protocolo de intervención. Método: Estudio analítico transversal en 18 zonas de salud de Canarias, con una población a estudio de 385.049 personas, usando variables sociodemográficas procedentes de la tarjeta sanitaria, los diagnósticos y el uso de los recursos asistenciales obtenidos de la historia electrónica de salud de atención primaria (HSAP) y del conjunto mínimo básico de datos hospitalario, el estado funcional registrado en la HSAP y los fármacos prescritos en el sistema de receta electrónica. A partir de esos datos se estimó la concordancia entre estratificadores, se evaluó la capacidad de cada estratificador para predecir ingresos y se construyeron modelos para optimizar la predicción. Resultados: La concordancia entre los pesos de complejidad de los estratificadores fue fuerte (rho = 0,735) y la concordancia entre categorías de complejidad fue moderada (Kappa ponderado = 0,515). El peso de complejidad GMA predice el ingreso hospitalario mejor que el del CRG (área bajo la curva [AUC]: 0,696 [0,695-0,697] vs. 0,692 [0,691-0,693]). Se añadieron otras variables predictivas al peso GMA, obteniendo la mejor AUC (0,708 [0,707-0,708]) el modelo compuesto por GMA, sexo, edad, escalas de Pfeiffer y Barthel, existencia de reingreso y número de grupos terapéuticos prescritos. Conclusiones: Se constató una fuerte concordancia entre estratificadores y una mayor capacidad predictiva de los ingresos por parte de los GMA, que puede aumentarse añadiendo otras dimensiones

Objective: To compare the concordance of complexity weights between Clinical Risk Groups (CRG) and Adjusted Morbidity Groups (AMG). To determine which one is the best predictor of patient admission. To optimise the method used to select the 0.5% of patients of higher complexity that will be included in an intervention protocol. Method: Cross-sectional analytical study in 18 Canary Island health areas, 385,049 citizens were enrolled, using sociodemographic variables from health cards; diagnoses and use of healthcare resources obtained from primary health care electronic records (PCHR) and the basic minimum set of hospital data; the functional status recorded in the PCHR, and the drugs prescribed through the electronic prescription system. The correlation between stratifiers was estimated from these data. The ability of each stratifier to predict patient admissions was evaluated and prediction optimisation models were constructed. Results: Concordance between weights complexity stratifiers was strong (rho = 0.735) and the correlation between categories of complexity was moderate (weighted kappa = 0.515). AMG complexity weight predicts better patient admission than CRG (AUC: 0.696 [0.695-0.697] versus 0.692 [0.691-0.693]). Other predictive variables were added to the AMG weight, obtaining the best AUC (0.708 [0.707-0.708]) the model composed by AMG, sex, age, Pfeiffer and Barthel scales, re-admissions and number of prescribed therapeutic groups. Conclusions: strong concordance was found between stratifiers, and higher predictive capacity for admission from AMG, which can be increased by adding other dimensions

[Comparison of predictive models for the selection of high-complexity patients]. / Comparación de modelos predictivos para la selección de pacientes de alta complejidad.

OBJECTIVE: To compare the concordance of complexity weights between Clinical Risk Groups (CRG) and Adjusted Morbidity Groups (AMG). To determine which one is the best predictor of patient admission. To optimise the method used to select the 0.5% of patients of higher complexity that will be included in an intervention protocol. METHOD: Cross-sectional analytical study in 18 Canary Island health areas, 385,049 citizens were enrolled, using sociodemographic variables from health cards; diagnoses and use of healthcare resources obtained from primary health care electronic records (PCHR) and the basic minimum set of hospital data; the functional status recorded in the PCHR, and the drugs prescribed through the electronic prescription system. The correlation between stratifiers was estimated from these data. The ability of each stratifier to predict patient admissions was evaluated and prediction optimisation models were constructed. RESULTS: Concordance between weights complexity stratifiers was strong (rho = 0.735) and the correlation between categories of complexity was moderate (weighted kappa = 0.515). AMG complexity weight predicts better patient admission than CRG (AUC: 0.696 [0.695-0.697] versus 0.692 [0.691-0.693]). Other predictive variables were added to the AMG weight, obtaining the best AUC (0.708 [0.707-0.708]) the model composed by AMG, sex, age, Pfeiffer and Barthel scales, re-admissions and number of prescribed therapeutic groups. CONCLUSIONS: strong concordance was found between stratifiers, and higher predictive capacity for admission from AMG, which can be increased by adding other dimensions.

Advanced practice in case management: An essential element in the new complex chronicity care model. / Enfermería de Práctica Avanzada y gestión de casos: elementos imprescindibles en el nuevo modelo de atención a la cronicidad compleja en España.

The increased prevalence of complex chronic diseases in all stages of life, the progressive aging of the population, the prevalence of multimorbidity, polypharmacy, and loss of autonomy, have given rise to new needs in society. The current model of care is failing to meet these needs in an effective or sustainable way. People with complex chronic diseases are vulnerable, they deteriorate as diseases progress, and they require individualized and coordinated professional care that takes into account the progression of the disease, transitions and people's preferences. It is essential to determine a new care paradigm as a framework for the projects and actions that should be promoted to reach transversal, sustainable and quality care directed at people with complex and advanced chronic diseases in all stages of life. Different studies show that case management is an added value in terms of quality, safety and cost-effectiveness. However, its implementation in Spain is uneven and heterogeneous, and no regulations have yet been developed to give stability to this new nurse figure. The Ministry and the Autonomous Communities now have the responsibility to create regulations and institutionalize the figure of case management nurses/advanced practice nurses, with a clear definition of their professional competences and functions, as has been done in other countries.

Relación entre diagnósticos de enfermería y uso de recursos sanitarios / The connection between nursing diagnosis and the use of healthcare resources

Objetivo: El sistema sanitario está invirtiendo un 75% de sus recursos en la atención a pacientes crónicos, en los que el foco de asistencia debe ser el cuidado y no la curación. El personal de enfermería centra su trabajo en dicho cuidado. El cuidado requiere de un registro a través de los lenguajes estandarizados en las historias de salud. Estos registros permiten diversos análisis útiles para la toma de decisiones sanitarias y organizativas. Se propone conocer cómo los diagnósticos de enfermería se asocian a un mayor gasto sanitario total. Método: Estudio transversal observacional analítico basado en los datos de las historias de salud de atención primaria (Drago-AP), altas hospitalarias (CMBD-AH) y dispensaciones de recetas (REC-SCS) en pacientes mayores de 50años durante el periodo de 2012-2013 en la comunidad canaria. Se realiza análisis descriptivo, bivariante y multivariante para generar un modelo predictivo del uso de recursos. Variables independientes: Sociodemográficas (edad, sexo, tipo de afiliación, tipo de aportación farmacéutica) y diagnósticos de enfermería (DdE) existentes a finales de 2012. Variables dependientes: Recursos sanitarios consumidos durante el año 2013. Resultados: Un total de 582.171 pacientes cumplían criterios de inclusión. Un 53,0% eran mujeres, y la edad media era de 64,3 años (DE: 10,8 años); un 53,2% eran pensionistas. El 49,3% de la población incluida tienen algún DdE, con una media de 2,1 DdE por paciente incluido. El coste medio anual por paciente fue de 1.824,62€, con una mediana de 827,5€ y unos percentiles 25 y 75 de 264,1 y 1.824,7€, respectivamente. En el análisis bivariante este gasto se correlacionó significativamente con todas las variables demográficas y aumentó en presencia de diagnósticos de enfermería de forma significativa (ρ de Spearman=0,37: a mayor número de diagnósticos, mayor gasto). En el análisis multivariante, un primer modelo de regresión lineal conformado por las variables sociodemográficas explica el 13,70% (R2=0,137) de la variabilidad del logaritmo de los costes totales. Si a ese modelo le añadimos la existencia y el número de diagnósticos de enfermería, llegamos a una capacidad explicativa del 19,77% (R2=0,1977). Conclusión: Comparado con un modelo que consta solo de variables sociodemográficas, los diagnósticos de enfermería pueden elevar la capacidad explicativa del uso de recursos sanitarios (AU)

Aim: The health service invests up to 75% of its resources on chronic care where the focus should be on caring rather than curing. Nursing staff focuses their work on such care. Care requires being redorded in health histories through the standardized languages. These records enable useful analyses to organisational and healthcare decision-making. Our proposal is to know the association of between nursing diagnosis and a higher total expenditure on health. Method: An observational cross-sectional analytical study was performed based on data from electronic health records in Primary Care (Drago-AP), hospital discharges (CMBD-AH) and prescriptions (REC-SCS) of patients over 50 from 2012-2013 in the Canary Islands. A descriptive, bivariate and multivariate analysis was undertaken to create a predictive model on the use of resources. Independent variables: Sociodemographic (age, sex, type of health-care affiliation, type of prescription charge) and nursing diagnosis (ND) recorded in late 2012. Dependent variables: Resources consumed in 2013. Results: 582,171 patients met the criteria for inclusion. 53.0% of them were women with an average age of 64.3 years (SD 10.8 years). 53.2% were pensioners. 49% of the included population had an ND, with an average of 2.1ND per patient. The average costs per patient were 1824.62€ (with a median of 827.5€) 25 and 27 percentiles of 264.1€ and 1824.7€, respectively. The bivariate analysis showed a significant correlation between these expenses and all the demographic variables; the expenses increased when a nursing diagnosis has been made (Spearman’s rank=0.37: the more diagnoses, the more expenses). In the multivariate analysis, a first linear regression with the sociodemographic variables as independent variables explains 13.7% of the variability of the logarithm of the full costs (R2=0.137). If we add to this model the presence of nursing diagnoses, the explanatory capacity reaches 19.77% (R2=0.1977). Conclusion: Compared with a model that only consists of sociodemographic variables, nursing diagnoses can enhance the explanatory capacity of the use of healthcare resources (AU)

The connection between nursing diagnosis and the use of healthcare resources. / Relación entre diagnósticos de enfermería y uso de recursos sanitarios.

AIM: The health service invests up to 75% of its resources on chronic care where the focus should be on caring rather than curing. Nursing staff focuses their work on such care. Care requires being redorded in health histories through the standardized languages. These records enable useful analyses to organisational and healthcare decision-making. Our proposal is to know the association of between nursing diagnosis and a higher total expenditure on health. METHOD: An observational cross-sectional analytical study was performed based on data from electronic health records in Primary Care (Drago-AP), hospital discharges (CMBD-AH) and prescriptions (REC-SCS) of patients over 50 from 2012-2013 in the Canary Islands. A descriptive, bivariate and multivariate analysis was undertaken to create a predictive model on the use of resources. INDEPENDENT VARIABLES: Sociodemographic (age, sex, type of health-care affiliation, type of prescription charge) and nursing diagnosis (ND) recorded in late 2012. Dependent variables: Resources consumed in 2013. RESULTS: 582,171 patients met the criteria for inclusion. 53.0% of them were women with an average age of 64.3 years (SD 10.8years). 53.2% were pensioners. 49% of the included population had an ND, with an average of 2.1ND per patient. The average costs per patient were 1824.62€ (with a median of 827.5€) 25 and 27 percentiles of 264.1€ and 1824.7€, respectively. The bivariate analysis showed a significant correlation between these expenses and all the demographic variables; the expenses increased when a nursing diagnosis has been made (Spearman's rank=0.37: the more diagnoses, the more expenses). In the multivariate analysis, a first linear regression with the sociodemographic variables as independent variables explains 13.7% of the variability of the logarithm of the full costs (R2=0.137). If we add to this model the presence of nursing diagnoses, the explanatory capacity reaches 19.77% (R2=0.1977). CONCLUSION: Compared with a model that only consists of sociodemographic variables, nursing diagnoses can enhance the explanatory capacity of the use of healthcare resources.