Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia / Desarrollo del rol profesional de la enfermera en diabetes en Cataluña en atención especializada y en atención primaria

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p < 0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p < 0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p < 0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings

OBJETIVOS: Describir la educación terapéutica en diabetes en Cataluña y las diferencias según el ámbito asistencial donde esta se imparte (asistencia primaria [AP] y asistencia especializada [AE]). MÉTODO: Estudio descriptivo, transversal y comparativo en PE de AE y de AP en Cataluña. La muestra se obtuvo a partir de todos los PE de AE y una muestra aleatoria por conglomerados de PE de AP. Se utilizó el cuestionario del Study of European Nurses in Diabetes validado al español. RESULTADOS: Se analizaron 287 cuestionarios (24,3% AE y 75,6% AP). Se observó más formación en diabetes a nivel de máster, posgrado y formación continuada en AE (p < 0,001). Más programas de educación estructurada, escritos y que combinan las estrategias de educación individual y grupal en AE (p < 0,05). Los roles educador, asesor, investigador, director, colaborador e innovador así como el seguimiento de pacientes vía telemática están más desarrollados en AE (p < 0,05). En ambos grupos el grado de satisfacción laboral es elevado. CONCLUSIONES: 1) Los profesionales de enfermería de AE asumen más roles de enfermera clínica especialista, además de tener más formación en diabetes y educación terapéutica que los profesionales de AP. 2) En AE se trabaja en mayor proporción con programas de ETD estructurados pero en ambos ámbitos se debería mejorar. De acuerdo con los resultados obtenidos y la evidencia científica disponible sería necesario acreditar la formación de los PE que trabajan en la atención de personas con diabetes, aumentar la utilización de programas estructurados y la investigación propia en ambos ámbitos de asistencia

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia.

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p<0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p<0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p<0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings.

Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.

BACKGROUND: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. METHODS: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. RESULTS: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). CONCLUSIONS: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39531840.

Incidence, timing and risk factors associated with 1-year mortality after hospitalization for community-acquired pneumonia.

OBJECTIVE: To identify the incidence, causes, timing and risk factors associated with 1-year mortality in CAP patients after hospital discharge. METHODS: Adult patients with CAP who were admitted to a tertiary hospital from 2007 to 2011 were prospectively recruited and followed up for 1 year after hospital discharge. RESULTS: Of the 1284 patients discharged, 93 (7.2%) died within 1-year of leaving hospital. Sixty eight (73.1%) patients died in the first six months. The main reasons for 1-year mortality after hospital discharge were infectious diseases, mainly pneumonia, followed by acute cardiovascular events. Mortality from infectious diseases was higher during the first 6 months (86.1%), while the number of deaths from cardiovascular causes was stable throughout the months of follow-up. After adjustment for confounders, chronic obstructive pulmonary disease, diabetes mellitus, cancer, dementia, rehospitalization within 30 days of hospital discharge and nursing home were independently associated with 1-year mortality. The incidence of long-term mortality increased >50% when ≥4 risk factors were present (P < .001). CONCLUSIONS: Patients mainly died from infectious diseases and acute cardiovascular events in the first six months after leaving hospital for an acute CAP episode. Certain features may help to identify the risk of long-term mortality in CAP patients.

A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia.

BACKGROUND AND OBJECTIVE: The aim of this study was to identify the frequency of, reasons for, and risk factors associated with additional health-care visits and re-hospitalizations (health-care interactions) among patients with community-acquired pneumonia (CAP), within 30days of discharge from hospital. METHODS: This was an observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital in 2007-2009. Additional health-care interactions were defined as visits to a primary care centre or emergency department, and hospital readmissions within 30days of discharge. RESULTS: Of the 934 patients hospitalized with CAP, 282 (34.1%) had additional health-care interactions within 30days of discharge from hospital; 149 (52.8%) required an additional visit to a primary care centre and 177 (62.8%) attended the emergency department. Seventy-two patients (25.5%) were readmitted to hospital. The main reasons for additional health-care interactions were worsening of signs or symptoms of CAP and new or worsening comorbidities that were unrelated to pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to a primary care centre or the emergency department was alcohol abuse (OR 1.65; 95% CI: 1.03-2.64). Hospitalization in the previous 90days (OR 2.47; 95% CI: 1.11-5.52) and comorbidities (OR 3.99; 95% CI: 1.12-14.23) were independently associated with re-hospitalization. CONCLUSIONS: Additional health-care visits and re-hospitalizations within 30days of discharge from hospital were common among patients with CAP. This was mainly due to worsening of signs or symptoms of CAP and/or comorbidities. These findings may have implications for discharge planning and follow up of patients with CAP.

Factores de riesgo y autovaloración del pacienteen un primer episodio de cardiopatía isquémica / Risk factors and self-evaluation in patients presenting a first episode of ischemic heart disease

Objetivo. Identificar los factores de riesgo cardiovascular en los pacientes que presentan un primer episodio de cardiopatía isquémica y su percepción en relación con la importancia de los mismos. Material y métodos. Estudio multicéntrico, observacional transversal. Durante 3 meses (de septiembre a diciembre de 2000) se entregó un cuestionario a 59 pacientes que ingresaron por un primer episodio de cardiopatía isquémica en 4 hospitales de Catalunya. Los criterios de inclusión fueron: edad = 7 días y ausencia de complicaciones graves. El análisis de datos se realizó con el programa informático SPSS versión 10.0. Se realizaron tablas de contingencia, así como la prueba de la X2 o el test exacto de Fisher. Se llevó a cabo el cálculo de medias y de las desviaciones típicas, así como las pruebas de la t de Student, de la U de Mann-Whitney, el análisis de la varianza y el test de Kruskal-Wallis. Resultados. El 73 por ciento eran varones. Se observó infarto agudo de miocardio (IAM) en el 72 por ciento y angina de pecho en el 28 por ciento. La edad media fue de 56,8 años. El 36 por ciento eran fumadores; el 24 por ciento consideró que el tabaco no constituía un riesgo para su salud. Un 32 por ciento presentaba un consumo excesivo de alcohol. El 75 por ciento consideró que el alcohol era una sustancia vitalizante. Se observó hipertensión arterial en el 58 por ciento de los pacientes, diabetes mellitus en el 21 por ciento e hipercolesterolemia en el 68 por ciento. Un 35 por ciento presentaba obesidad y un 72,4 por ciento tomaba una dieta grasa; sólo el 7 por ciento consideró que su dieta no era adecuada o muy adecuada. El 60 por ciento eran sedentarios. Un 62 por ciento manifestó haber sufrido estrés en los últimos 6 meses y un 85 por ciento se considero satisfecho con su estilo de vida. El 73,7 por ciento creía que la cardiopatía isquémica alteraría mucho sus actividades de la vida cotidiana y que los cambios más difíciles serían la alimentación, el tabaco y el ejercicio físico. La información había sido regular o mala para el 34 por ciento de los pacientes. Discusión. La mayoría de los pacientes presentaba los factores de riesgo clásicos de la cardiopatía isquémica, pero la mayoría no los valoraba. Es necesario investigar los conocimientos y creencias, y adaptar la información a la realidad individual de cada paciente (AU)