Ansiedad, depresión, soledad y adopción del rol del cuidador de la persona en cuidado paliativo / Anxiety, depression, loneliness and role-taking in the caregiver of a person in palliative care

Introducción: Los cuidadores familiares de personas en cuidado paliativo (CP) se exponen continuamente a altas demandas de cuidado y a situaciones de angustia, lo que puede afectar su adopción del rol, ansiedad, depresión y percepción de soledad. Objetivo: Describir y correlacionar la ansiedad, depresión, soledad y adopción del rol en una muestra de cuidadores de personas en CP de Bogotá, Colombia.Materiales y métodos: Estudio cuantitativo transversal conducido en el primer semestre de 2021 con una muestra de 220 cuidadores familiares principales de personas en CP. Se usaron los instrumentos ROL, HADS y UCLA para medir la adopción del rol del cuidador, ansiedad y depresión, y soledad respectivamente. Fueron usados coeficientes de correlación de Pearson y modelos de regresión lineal para analizar la relación entre las variables. Resultados: El 75 % de las personas en CP tenían cáncer, el 63,2 % con índice de Karnofsky de 30 y con una edad promedio de 69,4 años. El 81,8 % de los cuidadores fueron mujeres, con edad promedio de 47,7 años, el 85,5 % cuida a la persona desde el momento del diagnóstico con una dedicación promedio de 20 h diarias de cuidado; además el 34,2 % se autorreportó enfermo. Los cuidadores que tuvieron menores puntajes de adopción del rol tendieron a presentar mayores niveles de ansiedad, depresión y soledad (p < 0,05). Conclusión: Se requieren intervenciones de cuidado transicional de cuidador familiar de la persona en CP dado su mayor riesgo de presentar soledad, ansiedad y depresión, que promuevan una adopción del rol satisfactoria y que, con ello, mejore los resultados en estos. (AU)

Introduction: Family caregivers of people in palliative care (PC) are continually exposed to high demands for care and situations of distress, which can affect their adoption of the role, causing anxiety, depression, and a perception of loneliness. Aim: To describe and correlate anxiety, depression, loneliness, and role adoption in a sample of caregivers of people in PC in Bogotá, Colombia. Materials and methods: A cross-sectional quantitative study was conducted in the first half of 2021 with a sample of 220 main family caregivers of people in PC. The ROL, HADS, and UCLA instruments were used to measure role-taking, anxiety, depression, and loneliness, respectively. Pearson’s correlation coefficients and linear regression models were used to analyze the relationship between variables. Results: 75 % of people in PC had cancer, 63.2 % with a Karnofsky index of 30 and a mean age of 69.4 years; 81.8 % of the caregivers were women, with an average age of 47.7 years; 85.5 % cared for the patient from the time of diagnosis, with an average dedication of 20 hours of care per day. In addition, 34.2 % self-reported illness. Caregivers who had lower role-adoption scores tended to have higher levels of anxiety, depression, and loneliness (p < 0.05). Conclusion: Transitional care interventions are needed for the family caregivers of people in PC given their greater risk of having loneliness, anxiety, and depression, to promote satisfactory role-taking and thus improve their results. (AU)

Effectiveness of a case management model for people with multimorbidity: Mixed methods study.

AIMS: The aim was to determine the impact of a case management model on indicators of health service utilization, polypharmacy, quality of life and dependency of patients with multimorbidity, and family caregiver overload in a group of patients insured with two insurance companies in the city of Bogotá (Colombia). DESIGN: This was a mixed methods study, which integrated a quantitative and qualitative component. METHODS: The study was conducted between July 2019 and March 2020. A quantitative component is based on a pre-experimental study with a single group and pre- and post-test measurements. Patients with multimorbidity with a medium or high level of complexity were included in the study. A sample of 317 patients and their caregivers was estimated. Following the completion of the intervention, a descriptive study that explored the perspective of nurses, patients and caregivers was developed to better understand the process and results from their own words and experience. A total of 17 dyads of patients and caregivers were interviewed, as well as six nurse managers. The integration strategy was developed based on a comparison made from the perspective of multiple stakeholders. RESULTS: The model's impact on quality of life, particularly in terms of social functioning and mental health, has been documented. Caregiver overload was reduced and an improvement in the adoption of the role was observed, aspects that converge with the experience of the dyads and the caregivers in the support and backing provided by the model. CONCLUSION: The intervention was structured in five modules: case detection, complexity screening, comprehensive assessment with various instruments, individualized care and follow-up plan, and plan assessment. The nurse manager role is confirmed as that of a professional with the leadership capacity to articulate disciplines and actors, whilst also dealing with the day-to-day needs of people with complex health conditions. IMPACT: A comprehensive and integrated approach to patients with multiple diseases in a health insurance context marked by access barriers and fragmentation of health services. The study provides quantitative and qualitative evidence of the benefits of the case management model in Colombia for patients with multiple diseases and their family caregivers, particularly in terms of the psychosocial dimensions of health-related quality of life and dependence assessment. A significant impact on the caregiver role, as well as an improvement in perception and trust in the health system, was observed as a result of the overcoming of administrative barriers achieved by the nurse case manager. The findings are considered to be extremely useful for decision-makers and insurers in developing a case management model focused on comprehensive and individualized care plans, as well as for individuals with multiple diseases and their caregivers.

Análisis del impacto presupuestal en Colombia de la prueba de HPV con genotipificación comparada con la citología / Budget impact analysis of primary screening with the HPV test and genotyping against conventional cytology in Colombia

Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de HPV y otras técnicas como la citología, ha demostrado su eficacia en el diagnóstico y tratamiento oportuno de lesiones asociadas con el cáncer de cuello uterino. Objetivo. Estimar el impacto presupuestal de la estrategia de detección temprana del HPV mediante la prueba de genotipificación combinada con la citología en comparación con la citología convencional, en mujeres de 30 a 65 años participantes en el programa de tamizaje de cáncer de cuello uterino en una Entidad Administradora del Plan de Beneficios en salud (EAPB) en Colombia. Materiales y métodos. Utilizando un árbol de decisiones y un modelo de Markov, se estimaron las implicaciones clínicas y los costos directos anuales de dos ciclos de tamizaje, diagnóstico y tratamiento, en una cohorte de mujeres. Las prevalencias de los resultados clínicos y los costos se tomaron de la base de datos de una EAPB y la información de la progresión, persistencia y regresión de los estados de salud provinieron del estudio ATHENA. Resultados. El esquema de tamizaje con la prueba de HPV, la genotipificación y la citología resultó en un ahorro de costos comparado con la citología convencional. El costo promedio por ciclo de tamizaje con la prueba de HPV se estimó en COP $129'201.363 y con la citología en COP $186'309.952, es decir, un ahorro de COP $57'108.589 (30,7 %). Conclusión. La implementación de la estrategia de tamizaje evaluada sugiere que habría ahorros derivados de la detección temprana de los estados de salud asociados con el desarrollo de cáncer de cuello uterino.

Introduction: The detection of the human papillomavirus (HPV) through the combination of the HPV test and other techniques such as cytology has impacted the detection and timely treatment of lesions associated with cervical cancer. Objective: To estimate the budgetary impact of the strategy of early detection of HPV with DNA test genotyping with reflex cytology versus conventional cytology in women aged 30 to 65 years attending the cervical cancer screening program at a health benefit managing entity in Colombia. Materials and methods: Using a decision tree and a Markov model, the clinical implications and direct costs of screening, diagnosis, and treatment were estimated in a cohort of women. The analysis considered two screening cycles and their annual costs. The data on the prevalence of clinical results and the costs were taken from the health managing entity. The information on the progression, persistence, and regression of the health states were taken from the ATHENA study. Results: The screening scheme with the HPV test, genotyping, and reflex cytology compared to conventional cytology was cost-saving. The average cost per screening cycle with the HPV test was estimated at COP $ 129,201,363 and with cytology at COP $ 186,309,952, i.e., a saving of COP $ 57,108,589 (30.7%). Conclusion: The implementation of the screening strategy under evaluation suggests prospective savings derived from the early detection of health states associated with the development of cervical cancer.

Indicadores de un programa de gestión en cuidado paliativoen Colombia: seguimiento retrospectivo / Indicators of a palliative care management program in Colombia: a retrospective follow-up

Objetivo: Comparar el seguimiento a indicadores de cuidado paliativo (CP) de un programaimplementado en Bogotá, Colombia, entre marzo de 2019 y febrero de 2020.Materiales y métodos: Estudio descriptivo, comparativo, retrospectivo desarrollado con baseen los indicadores de un programa de CP. La muestra correspondió a una cohorte de 391 personas. Fueron considerados indicadores: la frecuencia de eventos hospitalarios, días de estanciahospitalaria, admisiones a unidad de cuidado intensivo (UCI), consulta a urgencias, consumode opioides, frecuencia de uso de servicios profesionales, dolor, bienestar, calidad de vida,satisfacción y uso de recursos financieros.Resultados: Se reportó menor frecuencia de eventos hospitalarios, uso de cuidados intensivos,consulta a urgencias (p < 0,01), mayor consumo de opioides en el último mes de vida (p < 0,01)y menor gasto de recursos financieros (p < 0,01) en los usuarios del programa de CP comparadoscon los usuarios susceptibles de CP. Se reportó una frecuencia de uso de servicios profesionalespor paciente y por mes entre 0,86 y 3,6, siendo la consulta por terapia respiratoria y enfermeríalos más frecuentes. Se observaron indicadores de satisfacción y bienestar por encima del 80 %,mientras que el control del dolor estuvo en el 74,1 %.Conclusión: Existen efectos potenciales de la inclusión de pacientes en un programa de CPsobre la percepción del bienestar, control del dolor y satisfacción del paciente con efectos quese extienden al uso de recursos en salud y su consecuente contención del gasto financiero. Serequieren estudios futuros que permitan establecer relaciones causales entre el programa conlos resultados financieros y los de los pacientes. (AU)

Aim: To compare follow-up among palliative care (PC) indicators of a program implemented inBogotá, Colombia, between March 2019 and February 2020.Materials and methods: A descriptive, retrospective study was developed based on the indicatorsof a PC program. The sample involved a cohort of 391 people. Considered indicators includedfrequency of in-hospital events, days of hospital stay, admissions to the Intensive Care Unit(ICU), emergency room visits, opioid use, frequency of professional services, pain, well-being,quality of life, satisfaction, and use of financial resources.Results: A lower frequency was reported for in-hospital events, use of ICU, emergency roomvisits (p < 0.01), higher use of opioids in the last month of life (p < 0.01), and lower financialexpenses (p < 0.01) among users of the PC program compared with the those susceptible ofPC. The frequency of professional service usage per patient and by month was reported to bebetween 0.86 and 3.6, with respiratory therapy and nursing visits being most common. Satisfaction and well-being indicators were observed above 80 %, whilst pain management was 74.1 %.Conclusion: There are potential effects of the inclusion of patients in a PC program on well-beingperception, pain management, and patient satisfaction, with effects that extend to usage of healthresources and consequent financial expense contention. Future studies are required that will allowestablishing causal relations between a PC program with positive financial results and patients. (AU)