Seguimiento de pacientes COVID-19 en aislamiento domiciliario mediante telemonitorización desde Atención Primaria / Follow-up for COVID-19 patients in home isolation through telemonitoring by Primary Care

El objetivo de este artículo es dar a conocer la experiencia de la implantación de la herramienta de teleseguimiento “TELEA” en el ámbito de Atención Primaria (AP) para la gestión de los casos COVID-19 en aislamiento domiciliario, así como describir su primer mes de implantación en el Área Sanitaria de Santiago de Compostela y Barbanza (septiembre de 2020).La herramienta TELEA existía previamente para el seguimiento de personas con patología crónica y se adaptó al seguimiento en casos COVID-19. El servicio incluía una clasificación inicial de los pacientes tras la notificación automática e inmediata de pruebas diagnósticas positivas de COVID: asintomático, bajo riesgo, con factores de riesgo o con signos de alarma. En los tres primeros casos se ofrecía a los pacientes seguimiento y monitorización mediante una plataforma digital donde registraban datos biométricos y síntomas respiratorios tres veces al día. Esos datos estaban enlazados a la historia clínica y eran monitorizados por la enfermera de AP. Alternativamente se realizó seguimiento telefónico proactivo por parte de la enfermera. Si presentaban signos de alarma eran derivados al hospital de referencia.Se hizo seguimiento en 220 de las 229 personas candidatas (el 78,6%; n= 173 mediante TELEA). El tiempo medio de seguimiento fue de 13,8 días, mayor en los pacientes incluidos en TELEA que en el seguimiento telefónico (p< 0,01). Ingresaron durante el seguimiento el 6,8 % de los pacientes, ninguno falleció.El teleseguimiento con telemonitorización domiciliaria basada en el control proactivo y protocolizado por parte de la enfermera de AP permitió un seguimiento clínicamente útil de pacientes con COVID-19 en aislamiento domiciliario.(AU)

The objective of this article is to make public the experience of implementing the telemonitoring tool “TELEA” in the Primary Care (PC) setting for the management of COVID-19 cases in home isolation, as well as to describe its first month of implementation at the Santiago de Compostela and Barbanza Health Area (September 2020).The TELEA tool was previously used for the follow-up of persons with chronic conditions, and was then adapted for the follow-up of COVID-19 cases. The service included an initial classification of patients after the automatic and immediate report of positive COVID diagnostic tests: asymptomatic, low risk, with risk factors or with warning signs. In the three first cases, patients were offered follow-up and monitoring through a digital platform where biometric data and respiratory symptoms were registered three times per day. These data were linked with the clinical record and monitored by the PC nurse. Alternatively, there was proactive follow-up by telephone by the nurse. If patients presented warning signs, they were referred to the hospital of reference.Follow-up was conducted for 220 of the 229 adequate persons (78.6%; n= 173 through TELEA). The mean follow-up time was 13.8 days, higher for the patients included in TELEA than for those with follow-up by telephone (p< 0.01). During follow-up, 6.8% of patients were admitted to hospital; none of them died.Remote follow-up with home telemonitoring based on the proactive management under protocol by the PC nurse allowed a clinically useful follow-up of patients with COVID-19 in home isolation.(AU)

Análisis de los problemas relacionados con la medicación en pacientes polimedicados mayores de 64 años en atención primaria. Un estudio descriptivo transversal / Analysis of drug-related problems in polymedicated patients over the age of 64 in primary care. A cross-sectional descriptive study

OBJETIVO: Identificar los problemas relacionados con la medicación mediante los criterios STOPP/START en pacientes polimedicados mayores de 64 años con 12 o más fármacos. MÉTODO: Estudio descriptivo transversal. Se analizaron 172 casos seleccionados aleatoriamente del registro de 1.500 pacientes polimedicados del Programa de Mejora de la Calidad en el Paciente Crónico y Polimedicado del Servicio Gallego de Salud para el área de Santiago en el 2017. Se registraron los problemas relacionados con los medicamentos y los resultados negativos asociados a la medicación. El incumplimiento terapéutico se evaluó mediante el test de Morisky-Green-Levine. Las intervenciones enfermeras se registraron a partir del informe enfermero del programa. Se realizó análisis bivariante de los datos y la asociación entre las variables se estimó mediante el cálculo de la odds ratio. RESULTADO: El 56,4% de las pacientes eran mujeres. La media de edad fue de 77,34±10,11 años. El problema más habitual fue la probabilidad de presentar efectos adversos, observándose en el 64,1% de los pacientes. Las mujeres presentaron mayor probabilidad de presentar este problema que los varones (OR: 1,37; IC 95%: 1,06-1,78). Un 18% de los pacientes se consideraron no cumplidores del tratamiento prescrito, según el test de Morisky-Green-Levine. Un 25,6% de los pacientes recibieron intervenciones de educación sanitaria. CONCLUSIONES: La enfermera debe reevaluar periódicamente la medicación de los pacientes para comprobar adherencia al tratamiento y conocer si están provocando algún tipo de efecto adverso, así como incorporar a su actividad intervenciones de educación para la salud en este campo

OBJECTIVE: To identify drug-related problems using the STOPP/START criteria of patients over 64 years polymedicated with 12 or more drugs. METHOD: Descriptive cross-sectional. We analysed 172 cases randomly selected from the register of 1500 polymedicated patients of the Quality Improvement Programme for Chronic and Polymedicated Patients of the Galician Health Service for the area of Santiago in 2017. Drug-related problems and the negative results associated with medication were recorded. Treatment compliance was assessed by the Morisky-Green-Levine test. Nursing interventions were recorded based on the Programme's nursing report. Bivariate analysis of the data was performed and the association between the variables was estimated by calculating the odds ratio (OR). RESULTS: The 56.4% of the patients were women. The mean age was 77.34±10.11 years. The most common problem was the likelihood of presenting adverse effects, observed in 64.1% of the patients. Women were more likely to have this problem than men (OR: 1.37; 95% CI: 1.06-1.78). Eighteen percent of the patients were considered non-compliant with the prescribed treatment, according to the Morisky-Green-Levine test. Of the patients, 25.6% had received health education interventions. CONCLUSIONS: Nurses must periodically re-evaluate patient medication to check adherence to treatment and determine whether it is causing any type of adverse effect, as well as incorporate health education interventions in this field into their activity

Analysis of drug-related problems in polymedicated patients over the age of 64 in primary care. A cross-sectional descriptive study. / Análisis de los problemas relacionados con la medicación en pacientes polimedicados mayores de 64 años en atención primaria. Un estudio descriptivo transversal.

OBJECTIVE: To identify drug-related problems using the STOPP/START criteria of patients over 64 years polymedicated with 12 or more drugs. METHOD: Descriptive cross-sectional. We analysed 172 cases randomly selected from the register of 1500 polymedicated patients of the Quality Improvement Programme for Chronic and Polymedicated Patients of the Galician Health Service for the area of Santiago in 2017. Drug-related problems and the negative results associated with medication were recorded. Treatment compliance was assessed by the Morisky-Green-Levine test. Nursing interventions were recorded based on the Programme's nursing report. Bivariate analysis of the data was performed and the association between the variables was estimated by calculating the odds ratio (OR). RESULTS: The 56.4% of the patients were women. The mean age was 77.34±10.11 years. The most common problem was the likelihood of presenting adverse effects, observed in 64.1% of the patients. Women were more likely to have this problem than men (OR: 1.37; 95% CI: 1.06-1.78). Eighteen percent of the patients were considered non-compliant with the prescribed treatment, according to the Morisky-Green-Levine test. Of the patients, 25.6% had received health education interventions. CONCLUSIONS: Nurses must periodically re-evaluate patient medication to check adherence to treatment and determine whether it is causing any type of adverse effect, as well as incorporate health education interventions in this field into their activity.