Assessing a care programme for complex and advanced chronic patients: Use of resources and costs.

INTRODUCTION: The Public Health System of the Balearic Islands (IB-Salut) implemented between 2016 and 2019 the Chronic Patient Care Plan to properly manage complex chronicity and provide quality care attention. The goal of this study is assessing the use of healthcare services and their associated costs before and after the implementation of the programme. METHODS: Descriptive analyses of resources destined to complex and advanced chronic patients (CCP and ACP). RESULTS: After entering the programme: the frequency of CCP admissions to acute hospitals reduced by 6.9%, the frequency of CCP visits to emergency departments reduced by 8.4%, while the frequency of ACP admitted to intermediate care hospitals increased. Both the frequencies of ACP admitted to acute hospitals and emergency visits decreased to 16.7% and to 27.3%, respectively. Total cost before and after the implementation of the programme was €60,884,241 and €46,889,693, respectively. Taking into account the 1011 admissions avoided, the result is a negative incremental cost-effectiveness ratio (€-396.57) per acute hospital admission that was avoided. CONCLUSION: The Chronic Patient Care Plan might be interpreted as a cost-effective intervention. This first assessment would benefit from further research including control groups.

Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular / Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone

OBJETIVO: Estudiar la concordancia entre los grados de satisfacción de los pacientes y sus familiares (ambos pertenecientes a un mismo núcleo familiar) en cuanto a los cuidados y atenciones proporcionados durante su estancia en la UCI. DISEÑO: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Pacientes mayores de 18 años con estancia mayor de 24h que fueron dados de alta de la UCI durante el período de estudio y familiares de dichos pacientes. Intervención: Instrumento: cuestionario FS-ICU 34 para evaluar la satisfacción de los familiares de pacientes ingresados en la UCI y adaptación de dicho cuestionario para el paciente. Se determina el grado de concordancia mediante el índice de kappa ponderado para muestras pareadas. RESULTADOS: Se analizaron todos los cuestionarios procedentes de un mismo núcleo familiar, obteniéndose un total de 148 pares de cuestionarios (296 encuestas). Se obtuvieron índices kappa que oscilaron entre 0,278 y 0,558, lo que indica grados de concordancia entre débiles y moderados. CONCLUSIONES: Los familiares de los pacientes ingresados en la UCI no pueden ser considerados unos representantes adecuados, al menos para el subgrupo de pacientes competentes. En estos casos debemos acudir a esos pacientes para conocer de primera mano sus sentimientos, percepciones y vivencias durante su estancia en la UCI. Solo cuando los pacientes no están en condiciones de participar activamente en el proceso asistencial debemos acudir a sus familias

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). Subjects: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. Intervention: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted

Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. / Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular.

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares / Measuring the satisfaction of patients admitted to the intensive care unit and of their families

Objetivo: Conocer el grado de satisfacción de los familiares de los pacientes dados de alta de la UCI y el del propio paciente. Diseño: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Familiares y pacientes que fueron dados de alta de la UCI durante ese período. Intervención Instrumento: encuesta Family Satisfaction Intensive Care Unit (FS-ICU 34) para familiares de pacientes ingresados en UCI (que sobrevivieron o no) y adaptación de la FS-ICU en cuanto a cuidados se refiere, para el propio paciente. Resultados: Se obtuvieron un total de 385 encuestas, 192 de familiares de supervivientes, 31 de familiares de fallecidos y 162 de pacientes. La mayor parte de los familiares encuestados estaban satisfechos con los cuidados recibidos y el proceso de decisiones (supervivientes: 83,46 ± 11,83 y 79,42 ± 13,58, respectivamente; fallecidos: 80,4 ± 17,27 y 79,61 ± 16,93, respectivamente). Los pacientes encuestados estaban muy satisfechos con los cuidados recibidos (84,71 ± 12,85). Conclusiones: El grado de satisfacción de los familiares y de los propios pacientes ingresados en la UCI es elevado. Aun así, existen varios puntos que deberían ser mejorados, como el ambiente de la sala de espera y el ambiente propio de la UCI en cuanto a ruido, intimidad e iluminación se refiere, así como algunos aspectos del proceso de toma de decisiones, entre ellos la esperanza suministrada acerca de la recuperación de su familiar

Objective: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. Design: A prospective, observational and descriptive study with a duration of 5 months was carried out. Setting The ICU of Marqués de Valdecilla University Hospital, Santander (Spain).Subjects Family members of adult patients admitted to the ICU and patients discharged to the ward. Intervention Instrument: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. Results: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46±11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). Conclusions: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative

[Measuring the satisfaction of patients admitted to the intensive care unit and of their families]. / Medición de la satisfacción de los pacientes ingresados en unidad de cuidados intensivos y sus familiares.

OBJECTIVE: To determine the level of satisfaction of family members with the care and decision making process, and to know the level of satisfaction of patients discharged from ICU. DESIGN: A prospective, observational and descriptive study with a duration of 5 months was carried out. SETTING: The ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Family members of adult patients admitted to the ICU and patients discharged to the ward. INSTRUMENT: Family Satisfaction Intensive Care Survey (FS-ICU 34) of family members of patients discharged to the ward. We adapted the FS-ICU 34 in relation to care for application to the patients. RESULTS: A total of 385 questionnaires were obtained: 192 from families of survivors and 162 from patients, and 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83.46 ± 11.83 and 79.42 ± 13.58, respectively; non-survivors: 80.41 ± 17.27 and 79.61 ± 16.93, respectively). Patients were very satisfied with the care received (84.71 ± 12.85). CONCLUSIONS: The level of satisfaction of the relatives of patients admitted to the ICU is high, in the same way as the degree of patient satisfaction. Still, there are several points that should be improved, such as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy and lighting. In relation to the decision making process, there are also some aspects that may be improved, such as the provision of hope regarding recovery of the critically ill relative.

Reacción urticariforme secundaria a terapia fotodinámica en 2 pacientes pediátricos / Urticaria-Like Reaction Secondary to Photodynamic Therapy in 2 Pediatric Patients

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