ABSTRACT
The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.
Subject(s)
Continuity of Patient Care , Hospitals , Primary Health Care , Continuity of Patient Care/organization & administration , Humans , Models, Organizational , Program EvaluationABSTRACT
Los pacientes atendidos en nuestro sistema sanitario tienen cada vez más edad y mayor prevalencia de enfermedades crónicas. Estas características de salud han condicionado que entre las expectativas de mayor relevancia de los pacientes, se indiquen la accesibilidad al sistema y la continuidad en los cuidados. La colaboración entre los distintos niveles asistenciales ha sido una herramienta reconocida que facilita la consecución de estas expectativas, provocando cambios en la organización del trabajo. Nuestro hospital ha desarrollado un modelo de atención sanitaria que en su orientación al enfermo facilita la colaboración entre los distintos niveles asistenciales, consiguiendo un grado de satisfacción de los profesionales elevado. En este trabajo se describe detalladamente parte del modelo, mostrando los elementos que lo caracterizan, indicando algunos parámetros de la evaluación de resultados y revisando la situación de los modelos de continuidad asistencial publicados. En resumen, consideramos que este sistema asistencial está dotado de elementos de gestión que permiten atender las expectativas de los usuarios, aportando beneficios para el paciente, el profesional y el sistema sanitario (AU)
The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike (AU)
Subject(s)
Humans , Primary Health Care/methods , Hospital Departments/methods , Cooperative Behavior , Patient Care , Spain , Program EvaluationABSTRACT
El desprendimiento de placenta normalmente inserta (DPPNI) se considera a partir de las 20 semanas de gestación; es responsable de un tercio de las hemorragias en el segundo y el tercer trimestre del embarazo, y es una de las causas más importantes de morbimortalidad maternofetal. En nuestro servicio se ha estudiado a 22 pacientes entre los años 2001 y 2003: gestantes que presentaron desprendimiento de placenta. Esto representa una incidencia del 0,56%. El factor principal de riesgo que se ha encontrado asociado a esta enfermedad es la enfermedad hipertensiva del embarazo (HIE), con 3 casos (13,6%). Ninguno de los casos se ha relacionado con el hábito tabáquico ni con el consumo de cocaína; ambos factores favorecen la vasoconstricción. Igualmente, a lo largo del embarazo en 4 de estas pacientes se diagnosticaron cuadros sugestivos de cólicos nefríticos, a los que en ninguna revisión bibliográfica se hace referencia como causa de DPPNI. Puede ser una coincidencia, dada la alta frecuencia de los cólicos nefríticos en la gestación. La presencia de hemorragia en el tercer trimestre fue del 100%, y hubo antecedentes de desprendimiento placentario y de cesárea anterior en 3 (13,6%) y tan sólo 6 (27,2%) casos, respectivamente. El diagnóstico se realizó anteparto, de forma temprana, ante la evidencia de la clínica en el 100% de los casos. Clínicamente, basándonos en la tríada sintomatológica, el signo más frecuente fue la hemorragia, por lo que las gestaciones terminaron por cesárea en el 100% de los casos, dado el compromiso y el riesgo de morbimortalidad maternofetal. Las complicaciones maternas observadas con más frecuencia fueron la anemia de moderada a grave, que requirió transfusión sanguínea en 8 (36,3%) pacientes, sin evidenciarse otra afección; en estos casos se descartó una alteración de la coagulación intravascular diseminada. La morbilidad perinatal fue considerable, y destaca la prematuridad, en 11 casos (50%) sin evidenciarse mortalidad alguna, posiblemente, a causa del diagnóstico temprano obstétrico realizado en nuestro servicio. Todos los casos se trataron de forma expectante y con excelentes resultados perinatales (AU)
Placental abruption (DPNNI) is usually considered from the 20th week of pregnancy, and it is responsible for a third of the haemorrhages in the second and third trimesters of pregnancy. It is one of the most important causes of maternal and foetal morbidity and mortality. In our Department 22 patients have been studied during the years 2001-2003, that represent an incidence of placental abruption of 0.56%. The main risk factor found was associated with HIE pathology, hypertensive diseases in pregnancy, 3cases (13.6%). None of the cases were related to smoking or using cocaine, both of which cause vasoconstriction. Equally, four patients were diagnosed with nephritic colic type diseases throughout pregnancy, which does is not referred to in any literature review as a cause of DPNNI. I t may be only a coincidence, given the high frequency of nephritic colic during pregnancy. Haemorrhage in the third trimester was present in100% of the cases, and there were antecedents of placental abruption and previous caesarean section in 3 cases (13.6%) and 6 cases (27.2%) respectively All cases were diagnosed before labour, due to clinical signs in 100% of the cases. Clinically based on a triad of symptoms; the most frequent sign was haemorrhage and all pregnancies were terminated with caesarean section given the risk of maternal and foetal morbidity and mortality. The most frequent maternal complications were moderate to severe anaemia in 8 patients that required blood transfusion (36.3%), no other pathology was encountered or disseminated intravascular coagulation disease. Perinatal morbidity was high, mainly prematurity in 11 cases (50%) with no mortality, possibly due to early obstetric diagnosis in this department. All cases were monitored closely, with excellent perinatal results (AU)
