A motivational interview program for cardiac rehabilitation after acute myocardial infarction: study protocol of a randomized controlled trial in primary healthcare.

BACKGROUND: Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences and goals, which is the core of the motivational interview. The objective of this study was to evaluate the efficacy of a cardiac rehabilitation program with a motivational interview in patients discharged from hospital after acute myocardial infarction. METHODS/DESIGN: A randomized, non-pharmacological clinical trial in six primary healthcare centers in Barcelona (Spain) will assess whether a tailored cardiac rehabilitation program consisting of four motivational interviews and visits with family physicians, primary healthcare nurses and a cardiologist, coordinated with the reference hospital, results in better cardiac rehabilitation than standard care. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction will be randomized to a cardiac rehabilitation group with a motivational interview program or to standard primary healthcare. The main outcome will be physical function measured by the six-minute walk test, and the secondary outcome will be the effectiveness of secondary prevention: a composite outcome comprising control of blood pressure, cholesterol, diabetes mellitus, smoking and body weight. Results will be evaluated at 1,3 and 6 months. DISCUSSION: This is the first clinical trial to study the impact of a new primary healthcare cardiac rehabilitation program with motivational interviews for patients discharged from hospital after myocardial infarction. Changes in lifestyles and habits after myocardial infarction are a core element of secondary prevention and require patient-centered care strategies such as motivational interviews. Therefore, this study could clarify the impact of this approach on health indicators, such as functional capacity. TRIAL REGISTRATION: ClinicalTriasl.gov NCT05285969 registered on March 18, 2022.

[Monitoring a home care cohort]. / Seguimiento de una cohorte de atención domiciliaria.

OBJECTIVES: To evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities. To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death. DESIGN: Analytic study of the follow-up of a cohort for 3 years. SETTING: Primary health care teams in Catalonia, Spain. PATIENTS: One thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia. MAIN MEASUREMENTS: The following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis. CONCLUSIONS: The study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources.

Seguimiento de una cohorte de atención domiciliaria

Objetivo: Buscar oportunidades de mejora mediante la evaluación de la atención domiciliaria que ofrecen los equipos de atención primaria en nuestro entorno a las personas > 65 años de edad con enfermedades crónicas. Identificar cuáles son las variables del paciente y del servicio que recibe que se asocian con el deterioro funcional y cognitivo, ingreso en una residencia geriátrica, visita a urgencias, ingreso hospitalario o muerte. Diseño: Estudo analítico de seguimiento de una cohorte durante 3 años. Emplazamiento: Equipos de atención primaria de Cataluña. Participantes: En total, 1.300 pacientes > 65 años con enfermedades crónicas incluidos en el Programa de Atención Domiciliaria. Mediciones principales: Se recoge anualmente su estado de salud (Charlson, Barthel, Pfeiffer, Braden y Gijón), datos sobre el cuidador (Zarit), atenciones recibidas (social y sanitaria), sallud subjetiva (SF-12), visitas a urgencias, ingresos temporales y el resultado final: muerte, ingreso en residencias geriátricas u hospital. Los análisis principales se basarán e regresiones logísticas y una análisis de supervivencia. Discusión: El estudio permitirá identificar las características del paciente que tengan valor pronóstico, así como conocer las práticas de atención social y sanitaria que se asocian con una mejor supervivencia y un menor consumo de recursos sociosanitários(AU)

Seguimiento de una cohorte de atención domiciliaria / Monitoring a home care cohort

Objetivo. Buscar oportunidades de mejora mediante la evaluación de la atención domiciliaria que ofrecen los equipos de atención primaria en nuestro entorno a las personas > 65 años de edad con enfermedades crónicas. Identificar cuáles son las variables del paciente y del servicio que recibe que se asocian con el deterioro funcional y cognitivo, ingreso en una residencia geriátrica, visita a urgencias, ingreso hospitalario o muerte. Diseño. Estudio analítico de seguimiento de una cohorte durante 3 años. Emplazamiento. Equipos de atención primaria de Cataluña. Participantes. En total, 1.300 pacientes > 65 años con enfermedades crónicas incluidos en el Programa de Atención Domiciliaria. Mediciones principales. Se recoge anualmente su estado de salud (Charlson, Barthel, Pfeiffer, Braden y Gijón), datos sobre el cuidador (Zarit), atenciones recibidas (social y sanitaria), salud subjetiva (SF-12), visitas a urgencias, ingresos temporales y el resultado final: muerte, ingreso en residencias geriátricas u hospital. Los análisis principales se basarán en regresiones logísticas y una análisis de supervivencia. Discusión. El estudio permitirá identificar las características del paciente que tengan valor pronóstico, así como conocer las prácticas de atención social y sanitaria que se asocian con una mejor supervivencia y un menor consumo de recursos sociosanitarios

Objectives. To evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities. To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death. Design. Analytic study of the follow-up of a cohort for 3 years. Setting. Primary health care teams in Catalonia, Spain. Patients. One thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia. Main measurements. The following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis. Conclusions. The study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources