Dependencia funcional y deterioro cognitivo de pacientes con cáncer avanzado atendidos en domicilio / No disponible

Objetivo: evaluar la dependencia funcional y deterioro cognitivo de los pacientes con cáncer avanzado atendidos en sus domicilios dentro de un programa de cuidados paliativos desarrollado por una Unidad de Hospitalización a Domicilio perteneciente a un hospital de tercer nivel («agudos»). Material y método: se analizan 1.423 pacientes que corresponden a la totalidad de enfermos de cáncer avanzado atendidos por la unidad entre enero de 2000 y diciembre de 2005. Resultados: destaca la fuerte dependencia física y marcado deterioro cognitivo de los pacientes al ingreso en programa con media de índice de Barthel de 34 y test de Pfeiffer mayor de 4 en el 50% de los casos. La estancia media fue de 12,5 días (DS 18). El 56% (797) de los pacientes falleció en su propio domicilio, el 10,8 (153) reingresó en nuestro hospital y el 6,8 (97) se derivó a una Unidad de Cuidados Paliativos de hospital sociosanitario. Los pacientes que fallecieron en el domicilio eran mayores (71 años) que los que reingresaron en el hospital (66) (p < 0,01) y presentaron al ser incluidos en programa mayor nivel de dependencia funcional (Barthel medio: 22,3 y 49,5 respectivamente, p < 0,001) y deterioro cognitivo (Pfeiffer medio 5,8 vs. 2,5, p < 0,001). Conclusiones: la complejidad relacionada con la dependencia funcional y el deterioro cognitivo de los pacientes y, como consecuencia, con la carga de cuidados que necesitan, no determina el lugar de la muerte. La edad de los enfermos es un factor modulador de la ubicación del paciente a lo largo de la evolución de su enfermedad (AU)

Objective: To assess functional dependence and cognitive deterioration in patients with advanced cancer cared for at home as part of a palliative care programme developed by a Hospitalisation at Home Unit at a level-three (acute) hospital. Material and method: 1,423 patients were analyzed, representing all patients with advanced cancer cared for at the Unit between January 2000 and December 2005. Results: It was noted that patients had major physical dependence and marked cognitive deterioration when they entered the program, since 50% of cases presented a mean of 34 on the Barthel index and over 4 in Pfeiffer's test. Mean stay was 12.5 days (SD 18). 56% of patients (797) died at home, 10.8% (153) were readmitted to our hospital, and 6.8% (97) were referred to a palliative care unit of a socio-sanitary hospital. Patients who died at home were older (71 years) than those who were readmitted to hospital (66) (p < 0.01), and on entry to the program they displayed a higher level of functional dependence (Barthel mean: 22.3 and 49.5 respectively, p < 0.001) and cognitive deterioration (Pfeiffer mean 5.8 vs.2.5, p < 0.001). Conclusions: The complexity of patients' functional dependence and cognitive deterioration, and the resulting care burden, does not determine the place of death. Patient age is a regulatory factor with regard to where patients are cared for as their disease progresses (AU)

[Profile of primary care physicians in a health area: a cluster analysis]. / Perfil de los médicos de atención primaria en un área de salud: un análisis de clusters.

OBJECTIVES: To discover characteristics of primary care doctors. To find homogeneous groups of doctors. DESIGN: A basically descriptive crossover observational study. SETTING: Primary care doctors from a health area. PARTICIPANTS: The following variables were recorded on the 99 doctors who worked in Castellon Area 03 during 1992: age, gender, fixed or temporary post, rural or urban area, MIR training, primary care model, patient load, sole employment, drugs expenditure, number of pensioners and total number of patients registered. MEASUREMENTS AND MAIN RESULTS: We found a first group of older doctors, working mainly in the old model, for whom PC was not their sole employment; another younger group without MIR training and with an average patient load; the third group was women in temporary posts with a somewhat higher drugs expenditure; the fourth was doctors working in rural areas with a very low patient load; the fifth, final and youngest group was family doctors, with an average patient load, low expenditure and a high number of patients registered. We observed highly significant differences between groups. CONCLUSIONS: Doctors' age and gender divide them into different groupings; family doctors form one group. Multivariable, descriptive methods proved useful in finding, describing and classifying doctors and centres, etc., and could be of use in resource and action planning.