RESUMEN
BACKGROUND: In Spain, family is the main source of care for dependent people. Numerous studies suggest that providing informal (unpaid) care during a prolonged period of time results in a morbidity-generating burden. Caregivers constitute a high-risk group that experiences elevated stress levels, which reduce their quality of life.Different strategies have been proposed to improve management of this phenomenon in order to minimize its impact, but definitive conclusions regarding their effectiveness are lacking. METHODS/DESIGN: A community clinical trial is proposed, with a 1-year follow-up period, that is multicentric, controlled, parallel, and with randomized allocation of clusters in 20 health care centers within the Community of Madrid. The study's objective is to evaluate the effectiveness of a standard care intervention in primary health care (intervention CuidaCare) to improve the quality of life of the caregivers, measured at 0, 6, and 12 months after the intervention.One hundred and forty two subjects (71 from each group) ≥65 years, identified by the nurse as the main caregivers, and who provide consent to participate in the study will be included.The main outcome variable will be perceived quality of life as measured by the Visual Analogue Scale (VAS) of EuroQol-5D (EQ-5D). The secondary outcome variables will be EQ-5D Dimensions, EQ-5D Index, nursing diagnosis, and Zarit's test. Prognostic variables will be recorded for the dependent patient and the caregiver.The principle analysis will be done by comparing the average change in EQ-5D VAS value before and after intervention between the two groups. All statistical tests will be performed as intention-to-treat. Prognostic factors' estimates will be adjusted by mixed-effects regression models. Possible confounding or effect-modifying factors will be taken into account. DISCUSSION: Assistance for the caregiver should be integrated into primary care services. In order to do so, incorporating standard, effective interventions with relevant outcome variables such as quality of life is necessary. Community care nurses are at a privileged position to develop interventions like the proposed one. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov under code number NCT 01478295.
RESUMEN
Objetivos: estimar la prevalencia de problemas de cuidados en población vulnerablede un Área de Atención Primaria (AP).Material y métodos: estudio de diseño descriptivo transversal, realizado enun Área de Atención Primaria, durante el año 2007, con una población menorde 15 años y mayor de 75 años y con registro en Historia Clínica Informatizada(HCI). Se realiza una única medición en diciembre de 2007 delos diagnósticos enfermeros registrados en HCI de la aplicación corporativaOMI-AP. La explotación de datos se realiza a través de un lenguaje estructuradode consulta informática (SQL). Variables estudiadas: edad, sexo,etiqueta diagnóstica (NANDA II), número de consultas, duración del proceso(días) y motivo del alta de cuidados. Análisis estadístico: las variablescualitativas se describen con su distribución de frecuencias (%) y las variablescuantitativas se resumen con mediana y rango intercuartílico. El paqueteestadístico utilizado es el SPSS® versión 15.Resultados: población diana: 20,32% de la población total. Se diagnosticaron45.384 problemas; el 23,79% en población vulnerable. Diagnósticos prevalentes:ancianos: deterioro de la integridad cutánea (3,54%) y problemasde desempeño del rol cuidador (2,70% y 2,59%); niños: conductas generadorasde salud (32,97%). Ratio de visitas/diagnóstico: ancianos: 1,44 (1,00-1,93); niños: 1,2 (1,00 -1,51). Duración proceso: ancianos: 52 (18-73); niños:17 (7,3 36,6). Motivos alta: resolución (79%-85%), seguimiento controlado(14%-8,60%), no resolución (3%-0,5%), fallecimiento (3%-0%),abandono (1%-4,35%).Conclusiones: el sexo es un factor determinante del diagnóstico en ancianos.Los niños se mueven en diagnósticos positivos. La utilización de laetiqueta Conductas generadoras de salud crea dudas de buen uso a losinvestigadores. Destaca la presencia enfermera en situaciones de riesgo. Eltiempo de resolución se asocia a la dificultad de trabajar cambios actitudinalesy comportamientos saludables (AU)
Objectives: to estimate the prevalence of care problems in vulnerable populationin a Primary Care (PC) Area.Material and methods: cross-sectional descriptive design, performed in a PrimaryCare Area, throughout 2007, with a population under the age of 15years and over the age of 75 years and with a registry in ComputerisedClinical History (CCH). One single measurement of nursing diagnosesrecorded in the CCH of the corporate application OMI-AP is recorded inDecember 2007. Data analysis is performed using a structured computerisedconsultation language (SQL). Studied variables: age, gender, diagnosticlabel (NANDA II), number of consultations, process duration (days)and reason for care discharge. Statistical analysis: qualitative variablesare described in terms of their frequency distribution (%) and quantitativevariables are summarised using median and interquartile range. The statisticalpackage used is SPSS® version 15.Results: target population: 20,32% of the total population. 45,384 problemswere diagnosed; 23,79% in vulnerable population. Prevalent diagnoses:elderly: deterioration of skin integrity (3,54%) and carer role problems(2,70% and 2,59%); children: health generating behaviours (32,97%).Consultations/diagnosis ratio: elderly: 1,44 (1,00-1,93); children: 1,2 (1,00-1,51). Process duration: elderly: 52 (18-73); children: 17 (7,3-36,6). Reasonsfor discharge reasons: resolution (79%-85%), controlled follow-up(14%-8,60%), no resolution (3%-0,5%), death (3%-0%), discontinuation (1%-4,35%).Conclusions: gender is a key factor of diagnosis in elderly patients. Childrenhave positive diagnoses. The use of the Health generating behaviourslabel creates good use doubts in researchers. The nursing presencein situations of risk stands out. The timeframe for resolution is associatedwith the difficulty of working on attitude changes and healthy habits (AU)
