New models of care and multidimensional solutions for oncological patients in the post-acute SARS-COV-2 period: a "Second Phase" also for cancer patients.

In Italy, SARS-CoV-2 outbreak registered a high transmission and disease rates. During the acute phase, oncologists provided to re-organize services and prioritize treatments, in order to limit viral spread and to protect cancer patients. The progressive reduction of the number of infections has prompted Italian government to gradually loosen the national confinement measures and to start the "Second phase" of measures to contain the pandemic. The issue on how to organize cancer care during this post-acute SARS-CoV-2 phase appears crucial and a reassessment of healthcare services is needed requiring new models of care for oncological patients. In order to address major challenges in cancer setting during post-acute SARS-CoV-2 phase, this work offers multidimensional solutions aimed to provide a new way to take care of cancer patients.

Hospitalización domiciliaria sustitutiva del ingreso y facilitadora del alta: resultados y factores relacionados / Early-discharge and admission-avoidance hospital-at-home programs: outcomes and associated factors

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A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program.

BACKGROUND: Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence-based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. METHODS: This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. RESULTS: The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. DISCUSSION: This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial. TRIAL REGISTRATION: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women's Hospital.

[Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions]. / Intérêt d'une unité mobile multidisciplinaire extra-hospitalière de neuro-psychogériatrie intervenant en EHPAD : analyse de 288 interventions.

INTRODUCTION: Geriatrics Mobile Units are a new organisation operating in nursing homes. Their mission is to propose globally oriented neuro-psychiatric and geriatric care. The purpose of the study is to assess their activity and impact over a 21-month period. METHOD: A prospective single center study of UMNPG's data including intervention characteristics, patient characteristics, recommendations and reassessment after intervention. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days (Student's t-test). RESULTS: From March 2014 to December 2015, UMNPG conducted 288 interventions mainly for medical advices (81%), clinical assessments (54%) and health care team support (46%). The average age was 84.6±7.3years, 73.3% of whom were women. The patients were dependent (62% of GIR 1 or 2) with dementia (60%) and under several medications (83.7%). The symptoms were mainly agitation/aggression (76.4%), anxiety (75%), depression (66.7%), irritability (60.4%), aberrant motor behaviour (55.9%) and delusions (48.6%). The main proposals of UMNPG were a change in treatment (79.5%), a health care team support (85.4%) and hospitalization (8.4%). The rate of follow-up on recommendation was 83% on the 15th day and 80% on the 30th day. The rate of avoided hospitalizations was 16%. The average NPI-NH decreased (on day 0 NPI=50±19.2; on day 30 NPI=33.9±19.6, p<0.001). CONCLUSION: UMNPG-EHPAD intervenes for frail elderly residents with multiple disorders in crisis situations. Medical recommendations help to support people in nursing homes and decrease NPI-NH. UMNPG-EHPAD is part of geriatric network strengthening the city/hospital connection.

Chronique de la certification d'un établissement d'hospitalisation à domicile.

CERTIFICATION PROCESS OF A HOSPITAL AT HOME FACILITY: The certification visit by the French National Health Authority requires a high level of commitment and collaboration on the part of the teams of the healthcare facility concerned. Professionals from a hospital at home unit having obtained its Level A certification describe the process and explain how the approach helped to give meaning to collective action when caring for patients in their home.

Organization, quality and cost of oncological home-hospitalization: A systematic review.

BACKGROUND: Home-hospitalization might be a patient-centred approach facing the increasing burden of cancer on societies. This systematic review assessed how oncological home-hospitalization has been organized and to what extent its quality and costs were evaluated. RESULTS: Twenty-four papers describing parenteral cancer drug administration to adult patients in their homes were included. Most papers concluded oncological home-hospitalization had no significant effect on patient-reported quality of life (7/8 = 88%), but large majority of patients were satisfied (12/13, 92%) and preferred home treatment (7/8, 88%). No safety risks were associated with home-hospitalization (10/10, 100%). The cost of home-hospitalization was found beneficial in five trials (5/9, 56%); others reported no financial impact (2/9, 22%) or additional costs (2/9, 22%). CONCLUSION: Despite heterogeneity, majority of reported models for oncological home-hospitalization demonstrated that this is a safe, equivalent and acceptable alternative to ambulatory hospital care. More well-designed trials are needed to evaluate its economic impact.

[Experience of the hospital at home service]. / Retour d'expérience de l'hospitalisation à domicile.

A doctor coordinator within the Nancy hospital at home service shares his experience of the assessment by the National Health Authority, carried out as part of the V2014 certification process, in February 2016. This 'adventure' sparked in him the desire to become an assessor.

Usefulness of Hospital at Home in nosocomial infections: advantages and limitations / Utilidad de la Hospitalización a Domicilio en las infecciones nosocomiales: ventajas y limitaciones

Hospital at Home units allows ambulatory treatment and monitoring of complex and serious infections. Nosocomial infections produce an extension of the stay in hospital often specifying long intravenous treatments without any effective oral alternatives. Daily dosing of antimicrobial are easier to administer at home. The use of portable programmable pump infusion and elastomeric devices allow efficient and safe infusions for most antimicrobials at home. Some antibiotics against multidrug-resistant organisms of recent introduction have a suitable profile for outpatient intravenous treatment (AU)

Las unidades de Hospitalización a Domicilio permiten el tratamiento y control ambulatorio de infecciones graves y complejas. Las infecciones nosocomiales suponen una prolongación de la estancia hospitalaria precisando con frecuencia largos tratamientos intravenosos sin alternativa eficaz oral. Los antimicrobianos más sencillos de administrar en domicilio son aquellos con dosis única diaria. La utilización de bombas programables portátiles de infusión y de dispositivos elastoméricos permite infundir con eficacia y seguridad la mayoría de antimicrobianos. Algunos de los antibióticos frente a microorganismos multirresistentes de reciente introducción tienen un perfil muy adecuado para el tratamiento intravenoso ambulatorio (AU)

Evaluating the Use of a Stability Guideline for Long-Term Ventilator-Dependent Children Discharging to Home: A Quality Improvement Project.

INTRODUCTION: Defining stability before discharge for children with severe chronic lung disease requiring home ventilation has historically been dependent on an individual provider's opinion. METHODS: An institutional guideline based on expert opinion was used for patients who were first discharged home on mechanical ventilation. A retrospective review determined if the guideline was used. Electronic medical record changes were initiated to improve compliance with the guideline. RESULTS: The retrospective review showed that the guideline is documented in less than one third of patients, and 36% of patients met the requirements of the guideline before discharge. Following these results, electronic medical record documentation was changed. DISCUSSION: Results showed a low utilization rate for the discharge home guideline for patients receiving long-term ventilation. Utilization of electronic medical record charting can improve the tracking of stability guidelines and provide the opportunity to further define stability in ventilator-dependent children.

Everything safe? ­ Risk situations in advanced home care from the point of view of ventilated patients and their relatives / Alles sicher? ­ Risikosituationen in der häuslichen Intensivpflege aus Sicht beatmeter Patienten und ihrer Angehörigen.

Background: The number of home mechanically ventilated (HMV) patients has been growing for years. However, little is known about requirements, processes and effects of advanced home care, provided in distance from clinics and doctors. To date, safety related aspects of the above mentioned issues have scarcely been examined. Aim: Users of advanced home care were asked about their experiences and about situations in which they felt safe or unsafe. The aim was to gain insights into the daily care provision, explore safety risks from the users' point of view, and to develop new approaches to enhance patient safety in home care for the severely ill. Method: A qualitative explorative study has been carried out, based on semi-structured interviews (ventilated patients N = 21; relatives N = 15). Sampling, data collecting and data analysis were guided by principles of Grounded Theory. Results: Risk situations occur when (non-)verbal communication offers of HMV patients are overseen or misunderstood, patient- or technology related monitoring tasks are neglected, if coordination and collaboration requirements are undervalued and if negotiation processes as well as education and supervision needs are disregarded. Furthermore, nurses' lack of competence, self-confidence and professionalism may produce risk situations. Conclusion: Listen carefully to patients and relatives can help to identify quality shortcomings in advanced home care, to prevent risk situations and to develop patient-centered safety concepts for this particular setting.

Early discharge hospital at home.

BACKGROUND: Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. OBJECTIVES: To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. SEARCH METHODS: We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. SELECTION CRITERIA: Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes.   DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. MAIN RESULTS: We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI 0.40 to 0.98; N = 574, 4 trials, low-certainty evidence) and might slightly improve patient satisfaction (N = 795, low-certainty evidence). Hospital at home probably reduces hospital length of stay, as moderate-certainty evidence found that people assigned to hospital at home are discharged from the intervention about seven days earlier than people receiving inpatient care (95% CI 10.19 to 3.17 days earlier, N = 528, 4 trials). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people with a mix of medical conditionsEarly discharge hospital at home probably makes little or no difference to mortality (RR 1.07, 95% CI 0.76 to 1.49; N = 1247, 8 trials, moderate-certainty evidence). In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people undergoing elective surgeryThree studies did not report higher rates of mortality with hospital at home compared with inpatient care (data not pooled, N = 856, low-certainty evidence; mainly orthopaedic surgery). Hospital at home may lead to little or no difference in readmission to hospital for people who were mainly recovering from orthopaedic surgery (N = 1229, low-certainty evidence). We could not establish the effects of hospital at home on the risk of living in institutional care, due to a lack of data. The intervention might slightly improve patient satisfaction (N = 1229, low-certainty evidence). People recovering from orthopaedic surgery allocated to early discharge hospital at home were discharged from the intervention on average four days earlier than people allocated to usual inpatient care (4.44 days earlier, 95% CI 6.37 to 2.51 days earlier, , N = 411, 4 trials, moderate-certainty evidence). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence). AUTHORS' CONCLUSIONS: Despite increasing interest in the potential of early discharge hospital at home services as a less expensive alternative to inpatient care, this review provides insufficient evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

[Palliative care at home: patient care pathways and clinical characteristics]. / Patients en situation palliative en hospitalisation à domicile : trajectoires de soins et caractéristiques cliniques.

INTRODUCTION: The great majority of French people express their desire to receive palliative care at home. The objective of this study was to describe the clinical care pathways and characteristics of patient receiving hospital at home palliative care. METHODS: This study compared the care pathways and clinical characteristics of patients receiving palliative care at home in the Ile-de-France region in 2014. Retrospective data were extracted from the French medical information systems programme. RESULTS: 817 patients receiving palliative care at home were included in the study. They were older, more often referred to hospital at home by a primary care physician, had shorter lengths of stay and more often died at home compared to patients without palliative care. Palliative care patients mainly presented cancer and received frequent technical nursing care. The oldest patients (≥ 75 years old) more often presented neurodegenerative diseases, were less often transferred to hospital, and more often died at home compared to younger patients. A higher proportion of home deaths was observed in nursing home residents and patients who died at home required less technical nursing care. CONCLUSION: This study provides important information concerning admission to hospital at home, the frequent changes of places of care and the complexity of maintaining palliative care at home until the patient's death.

The carbon footprints of home and in-center peritoneal dialysis in China.

OBJECTIVE: The provision of healthcare itself is associated with abundant greenhouse gas (GHG) emissions. This study aims to determine the carbon footprints of peritoneal dialysis (PD) with the different modalities and treatment regimes. METHODS: A total of 68 subjects performed with PD treatment were enrolled in this study. Emissions factors were applied to data that were collected for energy consumption, travel, and procurement. RESULTS: The carbon footprints generated by the provision of PD treatment for the individual patient were calculated and normalized to a 2-l PD dialysate volume. The fixed emissions were higher in patients who received PD therapy in center than at home, mostly attributing to the consumption of electricity. Conversely, PD treatment performed in center yielded less variable emissions than that of at home, which resulted from reduced constituent percentage of waste disposal and transportation. Collectively, packaging consumption mostly contributed to the total carbon footprints of PD. CONCLUSION: This study for the first time demonstrates the delivery of PD is associated with considerable GHG emissions, which is mainly attributed to packaging materials, transportation, electricity, and waste disposal. These results suggest that carbon reduction strategies focusing on packaging consumption in PD treatment are likely to yield the greatest benefits.

[Telemedicine in hospital at home care]. / La télémédecine en hospitalisation à domicile.

A telemedicine project in a rehabilitation centre has been developed in the framework of hospital at home care, for patients discharged early after surgery. This project is the subject of a medico-economic study in cooperation with the Regional Healthcare Agency in order to assess its impact. The results are promising and herald major changes in the care pathway of patients cared for in the home, as digital technologies continue to develop.

Rates of Autism Spectrum Disorder Diagnosis Under the DSM-5 Criteria Compared to DSM-IV-TR Criteria in a Hospital-Based Clinic.

BACKGROUND: We aimed to determine whether there was a decrease in the number of children diagnosed on the autism spectrum after the implementation of the new diagnostic criteria as outlined in the Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition published in May 2013. METHOD: We reviewed 1552 charts of children evaluated at the Women and Children's Hospital of Buffalo, Autism Spectrum Disorders Clinic. A comparison was made of children diagnosed with autism spectrum disorder (autism, Asperger disorder, pervasive developmental disorder-not otherwise specified) from 2010 to May 2013 using the Diagnostic and Statistical Manual of Mental Health Disorders Fourth Edition, Text Revision criteria with children diagnosed from June 2013 through June 2015 under the Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition. RESULTS: Using χ(2) analysis, the 2013-2015 rate of autism spectrum disorder diagnosis (39%) was significantly lower (P < 0.01) than the 2010 to May 2013 sample years rate (50%). CONCLUSION: The rate of autism spectrum disorder diagnosis was significantly lower under the recently implemented Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition criteria.

Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial.

OBJECTIVE: To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR). PATIENTS AND METHODS: Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013. Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario, Canada. Consenting participants completed a preprogram survey, and clinical data were extracted from charts. Participants were referred to CR at 1 of 3 sites. After intake assessment, including a graded exercise stress test, eligible patients were randomized to supervised mixed-sex, supervised women-only, or home-based CR. Six months later, CR adherence and exit assessment data were ascertained. RESULTS: Of the 264 consenting patients, 169 (64.0%) were eligible and randomized. Twenty-seven (16.0%) did not attend, and 43 (25.4%) attended a different model. Program adherence was moderate overall (54.46%±35.14%). Analysis of variance revealed no significant differences based on per-protocol analysis (P=.63), but as-treated, home-based participants attended significantly more than did women-only participants (P<.05). Overall, there was a significant increase in functional capacity preprogram to postprogram (P<.001). Although there were no significant differences in functional capacity by model at CR exit based on per-protocol analysis, there was a significant difference on an as-treated basis, which sustained adjustment. Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs (P<.05). CONCLUSION: Offering women alternative program models may not promote greater CR adherence or functional capacity; however, replication is warranted. Other proven strategies such as action planning and self-monitoring should be applied. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01019135.

Scalable hospital at home with virtual physician visits: pilot study.

OBJECTIVES: To evaluate the safety, feasibility, and efficacy of a substitutive Hospital at Home (HaH) model where physician care was provided via 2-way biometrically enhanced tele-video for a 34-day care episode. STUDY DESIGN: Prospective, nonrandomized, quasi-experiment. METHODS: Using medical record and patient survey data, we compared patients cared for in HaH (n = 50) versus the traditional acute care hospital (n = 52). RESULTS: Patients in HaH had substantial contact with the HaH physician, as well as in-person visits with nurse practitioners and other care providers. HaH patients were more satisfied with their care in multiple domains and met illness-specific quality standards at similar rates to hospital comparison patients. Functional outcomes were notable for a trend toward improvements in activities of daily living among HaH patients. Compared with hospital patients at 90 days after discharge, HaH patients were less likely to experience a hospital readmission (adjusted odds ratio, 0.39; 95% CI, 0.21-0.72). CONCLUSIONS: This pilot study suggests that a scalable substitutive model of HaH using biometrically enhanced 2-way tele-video, virtual physician visits, and caring for patients over a 34-day episode is safe, feasible, highly satisfactory, and may be associated with substantial reductions in hospital readmissions.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD.

INTRODUCTION: Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. METHODS: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient's home from the PR center and the patient's preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient's exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). RESULTS: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. CONCLUSION: Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.

Hospitalización a domicilio. Una alternativa asistencial / Hospital at home. A care alternative

La hospitalización a domicilio (HADO) supone una alternativa asistencial capaz de dispensar asistencia médica de rango hospitalario a los pacientes en sus domicilios, cuando ya no precisan de la infraestructura hospitalaria. Proporciona una atención integral al enfermo de determinadas patologías crónicas y agudas y permiten a los niños enfermos permanecer en el domicilio, rodeados de sus familiares y en su entorno. En otros países la hospitalización a domicilio está ampliamente desarrollada en adultos y en el ámbito pediátrico. En España, aunque es una realidad creciente, resulta aún insuficiente y precisa un mayor desarrollo para proporcionar una atención adecuada de los niños enfermos en sus domicilios (AU)

Hospital at Home (HaH) is a care alternative capable of providing hospital range medical care to patients in their homes when they do not require the hospital infrastructure. It provides comprehensive care to the patient with certain chronic and acute conditions and permits ill children to remain at home, surrounded by their family and environment. In other countries, hospital at home is widely developed in adults and in the pediatric setting. In Spain, although in is growing at present, greater development to provide adequate care of ill children in their homes is still insufficient and precise (AU)

Competencias transversales de los profesionales que facilitan atención domiciliaria a pacientes crónicos / Transferable skills of healthcare professionals in providing homecare in chronically ill patients

OBJETIVO: Determinar, a partir de los análisis de los profesionales de atención domiciliaria, el grado de relevancia de las competencias no técnicas de esos profesionales dedicados a la atención de pacientes con enfermedades crónicas. DISEÑO: Investigación cuanti-cualitativa realizada en 2 fases: la 1. a entre noviembre de 2010 y marzo de 2011 y la 2. a entre diciembre de 2012 y agosto de 2013. Emplazamiento: Región Sanitaria de Barcelona ciudad. PARTICIPANTES: En la primera fase, 30 profesionales pertenecientes a 6 equipos de atención domiciliaria (3 del ámbito de la atención primaria y 3 del ámbito hospitalario). En la 2. a fase, 218 profesionales pertenecientes a 50 equipos de atención primaria (EAP) y a 7 programas deatención domiciliaria y equipos de apoyo sanitario y social (PADES). MÉTODO: Muestreo intencional en la 1. a fase y aleatorio en la 2. a. Se emplearon escalas tipo Likert y grupos focales. RESULTADOS: A partir de la identificación de 19 categorías competenciales en la 1. a fase del estudio, se establecieron, en la 2. a fase, 3 metacategorías competenciales: atención integral centrada en el paciente, organización interprofesional y entre niveles asistenciales y competencia relacional. CONCLUSIONES: Es necesario favorecer y garantizar las relaciones profesionales entre niveles asistenciales, la continuidad asistencial, la concepción biopsicosocial y la atención holística al paciente y a su entorno, contemplando emociones, expectativas, sentimientos, creencias y valores de pacientes y familiares. Es imprescindible el diseño e implementación de formación en competencias transversales en el ámbito de cada centro, a través de metodologías didácticas activas y participativas

AIM: To determine the relevance level of non-technical skills of those professionals dedicated to the healthcare of patients with chronic diseases, from an analysis of home care professionals. DESIGN: Quantitative and qualitative research conducted in 2 phases: 1. st from November 2010 to March 2011 and 2. nd from December 2012 to August 2013. SETTING: Health Region of Barcelona city. PARTICIPANTS: During the 1. st phase, 30 professionals from homecare teams (3 from Primary Care and 3 from Hospitals). In 2. nd phase, 218 professionals from 50 Primary Healthcare Centres and 7 home care programmes. Method: Purposive sampling in was used in the1st phase, and randomized sampling in the 2. nd phase. Likert scales and focus group were used. RESULTS: A total of 19 skill categories were identified in the 1. st phase. In the 2. nd phase 3 metacategories were established: comprehensive patient-centered care, interprofessional organization, and inter-health care fields and interpersonal skills. CONCLUSIONS: It is necessary to improve and secure the professionals relationships between levels of healthcare, continuity of healthcare, biopsychosocial model and holistic attention to patients and relatives, looking at emotions, expectations, feelings, beliefs and values. It is essential to design and implement continuing training in transferable skills in every healthcare centre, through active methodologies