ABSTRACT
BACKGROUND AND OBJECTIVES: A better understanding of factors associated with assisted living admission and discharge practices can help identify communities that are more likely to allow residents to age in place. This study examined how state regulations and assisted living organizational characteristics related to community admission and discharge practices for bathing, getting out of bed, and feeding. RESEARCH DESIGN AND METHODS: Using data from a representative sample of 250 assisted living communities in seven states and a database of assisted living state regulations, we employed multilevel logistic regression models to examine regulatory and organizational correlates of assisted living community admission and discharge practices for 3 activities of daily living (bathing, getting out of bed, and feeding). RESULTS: States' regulations were not associated with assisted living community admission and discharge practices. However, assisted living communities above the median in the number of personal care staff members per resident were 17% (95% confidence interval [CI]: 6.5%, 27.1%) more likely to admit residents who needed assistance with feeding and 25.4% (95% CI: -37.7, -13.2) less likely to discharge these residents. For-profit communities were more likely to admit residents with bathing and feeding limitations. DISCUSSION AND IMPLICATIONS: Organizational characteristics (e.g., for-profit affiliation, staffing levels) may, in part, drive admission and discharge practices, especially related to different care needs. The ability to house residents with advanced care needs may be influenced more by the organizational resources available to care for these residents than by states' admission and discharge regulations.
Subject(s)
Activities of Daily Living , Assisted Living Facilities , Patient Discharge , Humans , Assisted Living Facilities/organization & administration , United States , Aged , Patient Admission/statistics & numerical data , Male , Female , Logistic ModelsABSTRACT
BACKGROUND: In the U.S., assisted living (AL) is increasingly a site of death, and anxiety about dying has been identified in long-term care residents and their caregivers. Communication about death and dying is associated with better quality of life and care at end of life (EOL). OBJECTIVE: To understand communication behaviors used by AL residents and their informal caregivers (i.e., family members or friends) related to death and dying, and address communication needs or opportunities applicable to EOL care in AL. DESIGN: A thematic analysis of in-depth interviews and fieldnotes from a subsample of data from a 5-year NIA-funded study. SETTING/SUBJECTS: Participants included 15 resident-caregiver dyads from three diverse AL communities in Atlanta, Georgia in the U.S. MEASUREMENTS: Interview transcripts were coded for communication behavior. Concordances and discordances within dyads were examined. RESULTS: We identified a typology of four dyadic communication behaviors: Talking (i.e., both partners were talking with each other about death), Blocking (i.e., one partner wanted to talk about death but the other did not), Avoiding (i.e., each partner perceived that the other did not want to communicate about death), and Unable (i.e., dyads could not communicate about death because of interpersonal barriers). CONCLUSIONS: Older residents in AL often want to talk about death but are blocked from doing so by an informal caregiver. Caregivers and AL residents may benefit from training in death communication. Recommendations for improving advance care planning and promoting better EOL communication includes timing these conversations before the opportunity is lost.
Subject(s)
Caregivers , Communication , Family , Terminal Care , Humans , Caregivers/psychology , Female , Male , Aged , Terminal Care/psychology , Middle Aged , Aged, 80 and over , Family/psychology , Assisted Living Facilities/organization & administration , Attitude to Death , Interviews as Topic , Georgia , Quality of LifeABSTRACT
Las residencias para adultos mayores se han convertido en un servicio clave y cada día más demandado por las personas de la tercera edad que por diferentes razones terminan viviendo en estas instituciones. Por ese motivo, conocer cuál es el grado de satisfacción de sus residentes se convierte en un aspecto clave para la mejora de la calidad en el servicio. Este estudio evaluó la calidad del servicio prestado a los residentes de una residencia privada para mayores mediante la aplicación de una encuesta de satisfacción, basada en el modelo SERVPERF, donde se evaluó cada una de sus cinco dimensiones: elementos tangibles, fiabilidad, capacidad de respuesta, seguridad y empatía, y se agregó una nueva, la alimentación. Para la evaluación de los resultados se llevó a cabo análisis descriptivo, distribución de frecuencias, medias y desviación estándar, en una muestra de 58 adultos, durante los meses de mayo y junio de 2017. En general, se evidenció que los residentes se encontraban satisfechos con el servicio ofrecido; entre los aspectos positivos destacaban las habitaciones, los empleados y los horarios de visitas. Entre las causas de insatisfacción más importantes figuraron la alimentación y el miedo a sentir que puedan robarle sus enseres
Residences for the elderly have become a key service and are increasingly in demand by the elderly, who for different reasons end up living there; for this reason, knowing the degree of satisfaction of its residents becomes a key aspect in improving the quality of the service. This study evaluated the quality of the service provided to residents of a private residence for the elderly, through the application of a satisfaction survey, based on the SERVPERF model, which consisted of five dimensions: tangibles, reliability, responsiveness, assurance and empathy, as well as a new one, feeding. In order to evaluate the results, frequency distribution, means and standard deviation were carried out using a sample of 58 adults between may and june 2017. It could be seen, that the residents were generally satisfied with the service offered, in particular, the rooms, the employees and the visiting hours, although among some major causes of dissatisfaction were food and the fear of having their belongings stolen
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Quality of Health Care , Homes for the Aged/statistics & numerical data , Patient Acceptance of Health Care , Surveys and Questionnaires , Assisted Living Facilities/organization & administrationABSTRACT
Objective: To measure and assess differences by educational level in the place of death for cancer patients, and to determine whether patterns of geographical disparities are associated with access to palliative care services in the municipality of residence. Method: We analysed the death certificates of adults (older than 24) who died of cancer (ICD-10 C00 to C97) in Spain during 2015, either at home, in hospital or in a long-term care centre. Of the 105,758 individuals included in the study population, 75.2% lived in one of the 746 identifiable municipalities (more than 10,000 inhabitants). This individual database was combined with three economic databases at municipal level and with a directory of palliative care resources published by the Sociedad Española de Cuidados Paliativos. Multilevel models were estimated to predict the place of death according to individual characteristics. Generalised least squares regression models were then applied to the municipal effects estimated in the first stage. Results: The probability of dying in long-term care centre decreases as levels of education increase; the probability of dying at home, rather than in hospital, is higher for patients with higher education. Dying in hospital is an urban phenomenon. There are large differences between Spanish regions. Access to palliative services is only of marginal significance in accounting for the systematic differences observed between municipalities. Conclusions: Developing specific plans for palliative care, with an active role being played by primary care teams, may help improve end-of-life care in Spain
Objetivo: Medir y evaluar las diferencias por nivel educativo respecto al lugar de muerte de pacientes con cáncer en España, y determinar si los patrones de desigualdad geográfica están asociados con el acceso a servicios de cuidados paliativos en el municipio de residencia. Método: Analizamos los certificados de defunción de mayores de 24 años que murieron de cáncer (CIE-10 C00-C97) en España durante 2015, en el hogar, en el hospital o en una residencia sociosanitaria. Sobre una población total de 105.758 personas, el 75,2% vivía en uno de los 746 municipios identificables (más de 10.000 habitantes). La base de datos individual se combina con datos económicos de ámbito municipal y con el directorio de recursos de cuidados paliativos publicado por la Sociedad Española de Cuidados Paliativos. Se estiman modelos multinivel para predecir el lugar de la muerte de acuerdo con las características individuales. A continuación, se estiman modelos de regresión por mínimos cuadrados generalizados sobre los efectos municipales estimados en el modelo anterior. Resultados: La probabilidad de morir en casa, frente al hospital, es mayor en los pacientes con educación superior. Morir en el hospital resulta un fenómeno urbano. Hay grandes diferencias entre regiones. El acceso a los servicios paliativos solo tiene una importancia marginal en la explicación de las diferencias entre municipios. Conclusión: El desarrollo de planes específicos para cuidados paliativos, con un papel más activo de los equipos de atención primaria, puede ayudar a mejorar la atención sanitaria al final de la vida en España
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Cause of Death , Fatal Outcome , Neoplasms/mortality , Terminal Care/statistics & numerical data , Terminally Ill/statistics & numerical data , Hospice Care/statistics & numerical data , Retrospective Studies , Residence Characteristics , Attitude to Death , Educational Status , Spain/epidemiology , Assisted Living Facilities/organization & administration , Socioeconomic FactorsABSTRACT
O Serviço Residencial Terapêutico (SRT), substitutivo ao modo manicomial asilar de assistência, é uma das estratégias de atenção à saúde mental preconizadas pela Política Nacional de Saúde Mental do Ministério da Saúde. No processo de transformação do modelo da atenção em Saúde Mental faz-se necessária a busca incessante da redução das internações psiquiátricas - quantidade, frequência e duração...
Subject(s)
Humans , Male , Female , Health Policy , Mental Health , Mental Health Services , Assisted Living Facilities/organization & administrationABSTRACT
Dado el aumento de la esperanza de vida de la población en Cataluña y la incidencia de deterioro cognitivo a partir de los 65 años, los servicios de atención domiciliaria como las viviendas con servicios para personas mayores deben ir poniendo en práctica acciones preventivas que brinden una atención de calidad a las personas que podrían estar sufriendo un deterioro cognitivo y, al mismo tiempo, a sus cuidadores informales, para garantizar de esta forma una atención personalizada. Mediante este estudio se pretende dar a conocer el perfil de persona con posible deterioro cognitivo incipiente y el de los cuidadores y los factores de riesgo que se han desprendido de dicha investigación, como pueden ser la soledad y/o la observación insuficiente de los profesionales que les atienden (AU)
Given the growing life expectancy of the population in Catalonia and the incidence of cognitive deterioration as from age 65, the home care services, such as housing with services for older people, must implement preventive practices that provide a quality assistance to those who may be suffering from a cognitive deterioration and, at the same time, to their informal caregivers in order to ensure personalized attention. This research aims to highlight the profile of the person who might be suffering from an incipient cognitive deterioration, as well as that of the caregivers, and the risk factors which have been observed, such as solitude and/or insufficient observation of the professionals who assist them (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Assisted Living Facilities/organization & administration , Caregivers/psychology , Cognition Disorders/rehabilitation , Frail Elderly , Evaluation of Results of Preventive Actions , Risk FactorsABSTRACT
Objetivos: identificar el perfil sociosanitario de los pacientes atendidos por la enfermera gestora de casos hospitalarios (EGCH), conocer la situación de dependencia, los diagnósticos de Enfermería, los resultados previstos y las intervenciones en estos pacientes. Material y método: estudio descriptivo sobre los enfermos atendidos por las EGCH del Hospital General de Granada. Como instrumento para la recogida de los datos se utilizaron los informes al alta emitidos por las mismas. Variables estudiadas: sociodemográficas y sanitarias de las personas dependientes y sus cuidadores principales (índice de esfuerzo del cuidador (IEC)); situación de dependencia del paciente (índice de Barthel, test de Pfeiffer y escala de Braden); diagnósticos de Enfermería, resultados e intervenciones enfermeras. Resultados: fueron estudiados 218 pacientes. El 59,2% eran hombres. La media de edad fue de 71,12 años. Un 46,8% tenían dependencia severa. La mayoría viven solos (28,9%) o en pareja (23,7%). En un 43,8%de los casos, la figura de cuidador principal recaía en los hijos. La media de días de ingreso fue de 20,06. En un 89,9% el destino al alta fue el domicilio. El principal diagnóstico de Enfermería en los pacientes atendidos fue el Deterioro de la integridad cutánea. Conclusiones: el perfil del paciente atendido por la EGCH se corresponde con población anciana, con dependencia total o severa, con ingresos hospitalarios prolongados y con una alta prevalencia del diagnóstico de Enfermería Deterioro de la integridad cutánea. La actividad de las EGCH de coordinación con otros profesionales y servicios, así como las funciones de gestión de material, facilita la continuidad de los cuidados en el domicilio, en coordinación con Atención Primaria (AU)
Objectives: to identify the socio-sanitary profile of patients seen by the Hospital Case Management Nurse (HCMN), to learn about their dependency situation, diagnosis by the nursing staff, foreseen results, and interventions in said patients. Materials and methodology: descriptive study of patients seen by HCMNs in the Hospital General de Granada. Discharge reports issued by HCMNs were used as data collection tool. The socio-demographic and sanitary variables of dependent persons and their main caregivers were studied (Caregiver Strain Index (CSI)); as well as the patients level of dependency (Barthel Index, Pfeiffer Test and Braden Scale); diagnosis by the nursing staff, results and nurse interventions. Results: the study was conducted on 218 patients; 59.2% of said patients were male. Their average age was 71.12 years. Of these patients,46.8% had severe dependency. Most patients lived alone (28.9%)or with a partner (23.7%). In 43.8% of cases, the main caregiver role was played by their children. The average hospitalization days were 20.06.In 89.9% of cases, patients returned home after discharge. The main diagnosis by nursing staff for those patients seen was deterioration of the skin integrity. Conclusions: the profile of patients managed by HCMNs could be defined as an elderly population, with complete or severe dependency, with prolonged hospitalizations and a high prevalence of deterioration of the skin integrity as nursing staff diagnosis. The HCMNs activity in terms of coordination with other professionals and departments, as well as their management of materials, makes home care continuity easier, in coordination with Primary Care (AU)
Subject(s)
Humans , Case Management/organization & administration , Nursing Care/organization & administration , Assisted Living Facilities/organization & administration , Nursing Diagnosis/organization & administration , Continuity of Patient Care/organization & administration , Epidemiology, DescriptiveABSTRACT
Introducción: Los cuidadores informales garantizan el cuidado de los pacientes con demencia, prolongando la estancia en su domicilio. Objetivos: Describir las características de los pacientes con demencia de la provincia de Alicante, así como los perfiles y roles de los cuidadores implicados en su manejo. Pacientes y métodos: Estudio prospectivo multicéntrico realizado en 4 consultas de neurología de la provincia de Alicante (junio del 2009-enero del 2010). Inclusión consecutiva de familiares/cuidadores de pacientes con demencia. Analizamos: a) datos demográficos del paciente y cuidadores (edad/sexo, estado civil/laboral, estudios, parentesco); b) unidad de convivencia del paciente; c) motivación para el cuidado del cuidador principal (CP); d) roles del cuidador secundario (CS); e) nacionalidad del cuidador formal (CF) y origen remuneración (privada/institucional), y f) formación en demencias de los cuidadores. Resultados: Nuestros pacientes residen en su domicilio (74,8%). Principalmente, son mujeres (69%) con enfermedad de Alzheimer (78,4%) moderadamente grave (GDS 4-5, 71,6%). CP y CS son mujeres (72,1% vs 60,5%), de edad media, parentesco directo (hijo/a 64,3% vs 54,4%), nivel cultural bajo y amas de casa. Las primeras garantizan el cuidado por obligación moral (75%), las segundas se ocupan del ocio/estimulación del paciente (82,3%). Los grandes ausentes son los varones (73,3%), quienes residen lejos del familiar (52,4%). El CF es una mujer (91,7%), espanola (81,8%) con remuneración privada. Conclusiones: La mujer es el elemento principal en la red de cuidadores de pacientes con demencia: como CP, de apoyo o CF (todos con escasa formación en demencias), siendo el varón el gran ausente. Conocer la estructura de cuidados de estos pacientes facilitará su manejo (AU)
Introduction: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. Objectives: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. Patients and methods: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patients family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers knowledge of dementia. Results: Most of our patients live at home (74.8%), and are female (69%) with Alzheimers disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. Conclusions: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients (AU)
Subject(s)
Humans , Caregivers/psychology , Dementia/epidemiology , Assisted Living Facilities/organization & administration , Prospective StudiesABSTRACT
Objetivos. La psiquiatría comunitaria ha descansado principalmente en la utilización de dispositivos intermedios de salud metal de media y larga estancia. Persiste sin embargo en el sistema de salud mental un gran desequilibrio entre las necesidades asistenciales de los pacientes y la provisión de servicios comunitarios para el tratamiento de la patología psiquiátrica aguda y grave. Teniendo ésto en consideración, el objetivo principal de éste artículo es revisar la evidencia científica actual acerca de la eficacia y la viabilidad de implementar nuevos modelos de atención psiquiátrica que permitan llenar el vacío existente en la provisión de cuidados a los pacientes agudos y graves en la comunidad y en el medio hospitalario. El articulo, finalmente, propone un modelo de atención combinada y equilibrada (balanced care approach)en el que se integren de manera eficaz dentro del sistema de salud mental los elementos clave de las nuevas alternativas que se han desarrollado para el tratamiento de la patología mental aguda y grave tanto en el nivel hospitalario como comunitario. Material y método. Se ha llevado a cabo una revisión de la literatura actual para identificar los elementos esenciales del tratamiento de la enfermedad psiquiátrica aguda y grave. Para ello se revisaron las bases de datos Medline (1966-2010), EMBASE (1980-2010) y PsycINFO (1985-2010)usando las palabras clave relacionadas con: Tratamiento Asertivo-comunitario; Tratamiento Domiciliario; Intervención en Crisis; "Hospital Psiquiátrico de Día, Agudo"; Desinstitucionalización; Modelos de Servicios de Salud Mental. Resultados. Han sido identificados tres modalidades de atención psiquiátrica intensiva para el tratamiento de la patología psiquiátrica aguda y grave: Atención Intensiva y Continuada de Día (Acute Continuous Day Care -ACDC-), o también denominado "Hospital de Día de Agudos"; Atención Asertivo Comunitaria (Assertive Outreach Care -AOC-) y; Tratamiento Agudo Domiciliario (Home Acute Care -HAC-)que también incorpora Programas de Resolución de Crisis. La viabilidad y utilidad de implementar estas distintas alternativas de atención psiquiátrica intensiva a la patología psiquiátrica aguda y grave, está avalada por la evidencia científica existente. Sin embargo, en la revisión realizada se detectó que, aun cuando dichas alternativas de atención intensiva pueden ser consideradas como complementarias y podían por lo tanto combinarse para alcanzar una mayor eficacia en la recuperación clínica y social de los pacientes, lo cierto es que se implementan de manera independiente. No se dispone por lo tanto de evidencia científica acerca de la eficacia y viabilidad de un programa integrado de asistencia que incorpore los elementos clave de cada una de ellas. Conclusiones. Con el fin de avanzar en el Modelo Comunitario de atención a la enfermedad mental sería preciso incorporar en el Sistema de Salud Mental un "Subsistema de Atención Aguda Intensiva e Integrada" en el que se combinaran de manera eficiente y equilibrada las estrategias de intervención señaladas (AU)
Objectives. Community psychiatry has mainly relied upon intermediate long term care services while there is a large gap between patients needs and availability of acute care services. Taking this into consideration, the main aim of this paper is to review the evidence supporting the efficacy and feasibility of implementing the new models of care developed to fulfil the gap in the provision of community and hospital care for acute and severely ill patients. Finally the paper will propose a "care balanced approach" to integrate the key elements of the new alternatives of acute community and hospital care in the mental health system. Material and Method. A review of the current literature was used to identify the key components of acute care for psychiatric illness. For this purpose Medline (1966-2010), EMBASE (1980-2010), and PsycINFO (1985-2010) databases were reviewed using key terms relating to assertive outreach, home treatment/crisis resolution, psychiatric acute day care, deinstitutionalization, Mental Health Service Models. Results. Three main types of acute care have been identified: Acute Continuous Day Care (ACDC) -day hospitals-, Assertive Outreach Care (AOC) -Assertive Community and Assertive Outreach teams-, and Home Acute Care (HAC)-Crisis resolution, Home treatment teams-. The feasibility of these alternatives is supported by available evidence. Although these acute care alternatives may be complementary and could be combined for achieving a greater positive impact on the clinical and social recovery of the patients, there are usually implemented independently. Conclusions. An integrative acute care subsystem combining these three strategies in a balanced care system should be formally incorporated to the advanced community model in mental health care(AU)
Subject(s)
Humans , Mental Disorders/therapy , Hospitalization/statistics & numerical data , Community Mental Health Centers/organization & administration , Assisted Living Facilities/organization & administration , Day Care, Medical/organization & administration , Day Care, Medical , /statistics & numerical dataABSTRACT
Objetivo. Analizar la concordancia entre escalas de actividades básicas de la vida diaria (ABVD) y de deterioro cognitivo en centenarios. Método. Entrevista domiciliaria a todos los centenarios de nuestra área, cumplimentándose tres escalas de ABVD (índice de Katz [IK], índice de Barthel [IB] e índice de incapacidad física de la Cruz Roja [IFCR]), y dos de valoración de deterioro cognitivo (miniexamen cognoscitivo [MEC], y el índice de incapacidad psíquica de la Cruz Roja [IPCR]). Se valoró la concordancia mediante el índice kappa. Resultados. Se entrevistó a 80 centenarios, 26 hombres y 64 mujeres, media de edad, 100,8±1,3 años. Más de la mitad de los centenarios presentaron independencia funcional o dependencia leve, siendo los hombres independientes con más frecuencia (IB 70±34,4 frente a 50,4±36,3; p=0,005). Al valorar deterioro cognitivo, los resultados fueron discordantes, aunque los hombres presentaron menos deterioro cognitivo que las mujeres (MEC, 16,5±9,1 vs. 11,6±8,1; p=0,008). Los tres cuestionarios que miden ABVD (IK, IB, IFCR) clasificaron uniformemente a los centenarios; el IK y el IB clasifican igual al 95% de los centenarios (kappa, 0,899), el IB y el IFCR al 97,5% (kappa, 0,95) y el IK e IFCR al 97,5% (kappa, 0,95). La concordancia en los cuestionarios de deterioro cognitivo fue muy baja; se clasificaron igual al 58,8% de los centenarios (kappa, 0,295). Conclusiones. Cualquiera de las tres escalas de ABVD es útil en pacientes centenarios. Sin embargo, está por definir cómo valorar el deterioro cognitivo(AU)
Objective. To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. Method. A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. Results. A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). Conclusions. Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined(AU)
Subject(s)
Humans , Male , Female , Cognition Disorders/epidemiology , Home Care Services/statistics & numerical data , Home Care Services/standards , Assisted Living Facilities/organization & administration , Assisted Living Facilities , Repertory, Barthel , Active Life Expectancy , Surveys and Questionnaires , Brief Psychiatric Rating Scale/standards , Psychiatric Status Rating Scales/statistics & numerical data , Psychiatric Status Rating Scales/standardsABSTRACT
Objetivo: Evaluar si un programa de automedida domiciliaria de presión arterial (AMPA) es eficaz para obtener una menor inercia terapéutica (IT) en el tratamiento de la HTA. Diseño: Estudio clínico controlado, aleatorizado y multicéntrico. Emplazamiento: 35 centros de salud de España. Participantes: Se incluyeron 232 hipertensos. Intervención: Se formaron 2 grupos con 116 individuos: 1, grupo de control (GC): recibieron la intervención habitual; 2, grupo de intervención: se inscribieron en un programa de AMPA. Mediciones principales: La IT se midió mediante el cociente: (Número de pacientes sin modificación del tratamiento farmacológico en cada visita / Número de pacientes con cifras medias de PA ≥ 140 mmHg y/o ≥ 90 mmHg en población general o ≥ 130 y/o 80 mmHg en diabéticos) y multiplicado por 100. Se calculó la IT por visitas, las PA medias y grado de control de la HTA. Resultados: Concluyeron 209 individuos (edad media 69,28±11,6 años) (p=NS por grupos) (GI 107 individuos y GC 102).La IT fue 35,64% de las visitas de la muestra (IC=29,85-41,43%) y en el 71,63% (IC=63,9-79,36%) en hipertensos no controlados. La IT fue del 22,42% (IC=24,2-37%) en el GI y 50% (IC=37,75-62,25) en el GC (p < 0,05) en visita 2, y del 25,23% (IC=14,84-35,62) y 46,07% (IC=33,85-58,29) en visita final para GI y GC respectivamente (p<0,05). Conclusiones: La IT ha sido muy relevante. El programa de AMPA es eficaz para obtener una menor IT(AU)
Objective: To evaluate the efficacy of a program of home blood pressure monitoring (HBPM) on therapeutic Inertia (TI) in mild-to-moderate hypertension (AHT). Design: Controlled, randomised clinical trial. Setting: Forty six clinics in 35 primary care centres. Spain. Participants: A total of 232 patients with uncontrolled hypertension were included. Intervention: Two groups with 116 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention group (IG): patients who were included in the HBPM program. Main measurements: TI was calculated by the ratio: Number of patients whose pharmacological treatment was not changed in each visit/Number of patients with an average BP 140mmHg and/or 90mmHg in the general population or 130 and/or 90 mmHg in diabetics. The mean BPs and the percentage of controlled patients were calculated. The mean number of people that required an intervention in order to avoid TI was calculated (NI). Results: A total of 209 patients completed the study, with TI in 35.64% (95% CI=29.85%-41.43%) of the sample, and in 71.63% (95% CI=63.9-79.36%) of the uncontrolled hypertensive patients. The TI was 22.42% (95% CI=24.2-37%) in the IG and 50% (95% CI=37.75-62.25) in the CG (p<.05) in visit 2, and 25.23% (95% CI=14.84-35.62) and 46.07% (95% CI=33.85-58.29) in the final visit for IG and CG, respectively (P<.05). The NI was 4.3. Conclusions: TI was very significant among the uncontrolled hypertensive patients. The studied interventions are effective for improving TI(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hypertension/diagnosis , Hypertension/therapy , Patient Care Management/ethics , Patient Care Management/legislation & jurisprudence , Patient Care Management/methods , Assisted Living Facilities/organization & administration , Assisted Living Facilities , Hypertension/etiology , Hypertension/prevention & control , Patient Care Management/statistics & numerical data , Patient Care Management/standards , Assisted Living Facilities/standards , Assisted Living Facilities/trendsABSTRACT
Comienza a ser habitual que los pacientes sean dados de alta hospitalaria precozmente y que continúen requiriendo cuidados de una herida después de la misma. El objetivo de este trabajo fue describir la experiencia del paciente que retorna al hospital para realizar la cura y el seguimiento de la herida. Metodología: estudio descriptivo con técnicas cualitativas realizado de julio a septiembre de 2005, en el hospital municipal Fortaleza-Ceará. Datos recogidos a través de un guión de entrevista semi-estructurada aplicada a ocho pacientes en el momento del retorno al hospital. Resultados: los datos referidos a las declaraciones de los pacientes fueron organizados en categorías a partir del análisis y la agrupación de los mismos. Identificamos en los pacientes sentimientos de tristeza, miedo, inseguridad y fuga frente a la existencia de la herida, que se contrarrestan con la percepción de profesionalidad y disponibilidad de buenos medios técnicos y materiales en el medio hospitalario. Las orientaciones de Enfermería son consideradas importantes por los pacientes e incentivan el autocuidado (AU)
It is becoming standard for patients to be discharged son after their surgery and for them to continue requiring wound care after discharge. The objective of this paper is to describe the experience of the patient who return for woundcare and follow up after discharge. Methodology: descriptive study with qualitative techniques carried out between july and september 2005, at the Fortaleza-Ceará district hospital. Data were compiled by means of a semi structured interview administered to eight patients at the time of their return to the hospital to have their wound examined. Results: data obtained from the patients responses were organised into categories based on the analysis and grouping of such data. Feelings of sadness, fear, insecurity and a feeling to run awaywere identified in the patients when faced with the existence of the wound. These feelings are counteracted by the sense of professionalism and availability of good technicalmeans and materials in the hospital setting. Nursing recommendations and advice are considered as important by the patient and incentivise self-care (AU)
Subject(s)
Humans , Patient Discharge/trends , Continuity of Patient Care/organization & administration , Assisted Living Facilities/organization & administration , Patient Care Management/methods , Self-Care Units/organization & administrationABSTRACT
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