Perceived quality of healthcare in a multicenter, community-based population of polypathological patients.

The objective was to determine perceived quality of care (PQC) in patients with multiple chronic conditions, whose care is structured in Andalusia (Spain) under polypathological patients (PP) care process, and identifying aspects for its improvement. The study was a community-based cross-sectional survey carried out in 4 primary care centers (which attended a total of 62,702 adults, of them, 662 were actively identified as PP). Finally, 461 PP and their caregivers were interviewed (69% of eligible population) including assessment of PQC following SERVQUAL model, clinical and demographical data. On a five-point Likert scale (from 1, 'much worse than expected'; to 5, 'much better'), PQC rated 3.68±0.59 (±S.D.). Independent PQC predictors were: empathy for family physician, identifying nurses, presence of peripheral artery disease or diabetes mellitus with vascular complications, and not having functional limitations. In this population-based survey, PP attended at primary care have an acceptable PQC. Measures aimed to lessening functional deterioration, supporting dependent patients, and improving relationship between PP and their healthcare professionals could increase PQC.

[Overload felt by the figure of the main caregiver in a cohort of patients with multiple pathologies]. / Sobrecarga sentida por la figura del cuidador principal en una cohorte de pacientes pluripatológicos.

OBJECTIVE: To determine the profile of the main caregiver (MC) and the factors associated with her/his care burden, in a multi-centre cohort of patients with multiple pathologies (PMP). DESIGN: Multi-centre cross-sectional study. SETTING: Four health districts in the Virgen del Rocío University Hospitals Health Area, Seville, Spain. PARTICIPANTS: The PMP cohort was created by checking all the patients who satisfied the health department criteria for PMP (2002): patients suffering from chronic diseases in 2 or more of the 7 clinical categories defined. MAIN MEASUREMENTS: The profile of PMP caregiver was determined for all patients. The caregiver strain index (CSI) was determined by the index of care stress (ICS). Predictive factors were analysed by the Student t, ANOVA, and Pearson's tests. Multivariate analysis was performed by a forward stepwise linear regression model. RESULTS: The interview was attended by 461 (69%) out of 662 eligible PMP. Of these, 293 (63.6%) had an MC whose mean age was 62 (15) years; 80% of them were women. First-degree relatives made up 88% of caregivers, with spouses 49.7% of them (n=146). In 41.5%, the CSI was >7 points (mean CSI was 5.35 [3.5]). This was higher in those caring for PMP with neurological illnesses (7 [3.2 vs 4.5 [3.3]; P=.0001). The CSI was compared directly with the medical vulnerability of the PMP (R=0.37; P=.001), cognitive deterioration on the Pfeiffer scale (PS) (R=0.4; P=.0001), and inversely with functional status on Barthel's scale (BS) (R=-0.67; P=.0001). Patient's age (P=.03), his/her medical vulnerability (P=.016) and functional (P< .0001) and cognitive (P=.019) deterioration were independently associated with the CSI. CONCLUSIONS: The profile of the MC of the PMP cohort corresponded mainly to first-degree female relatives around sixty years old. The burden of care was high in more than a third of them. Predictive factors were age, medical vulnerability, and the functional and cognitive deterioration of the PMP.

Sobrecarga sentida por la figura del cuidador principal en una cohorte de pacientes pluripatológicos / Overload felt by the figure of the main caregiver in a cohort of patients with multiple pathologies

Objetivo. Conocer el perfil del cuidador principal (CP) y los factores relacionados con la sobrecarga sentida, en una cohorte multicéntrica de pacientes pluripatológicos (PP). Diseño. Estudio transversal, multicéntrico. Emplazamiento. Cuatro zonas básicas de salud del área sanitaria de los Hospitales Universitarios Virgen del Rocío, Sevilla. Participantes. La cohorte de PP se generó prospectivamente mediante el censado de todos los pacientes que cumplían los criterios de PP de la Consejería de Salud (2002): aquellos que tienen enfermedades crónicas de dos o más de las 7 categorías clínicas definidas. Mediciones principales. El perfil del cuidador se determinó a todos los PP. El cansancio del CP se determinó mediante el índice de esfuerzo del cuidador (IEC). Los factores predictores se analizaron mediante los tests de la t de Student, ANOVA y Pearson. Posteriormente se realizó una regresión lineal multivariable paso a paso hacia delante. Resultados. Accedieron a la entrevista 461 (69% de los 662 elegibles) PP; 293 (63,6%) pacientes tenían CP, que en el 88% eran familiares de primer grado (146 [49,7%] de ellos, el cónyuge), de 62 ± 15 años de edad, y el 80%, mujeres. El IEC fue > 7 puntos en el 41,5% y en general fue 5,35 ± 3,5, mayor en los que cuidaban de PP con enfermedades neurológicas (7 ± 3,2 frente a 4,5 ± 3,3; p < 0,0001). El IEC se correlacionó directamente con la vulnerabilidad clínica del PP (R = 0,37; p < 0,001), con el deterioro cognitivo por escala de Pfeiffer (R = 0,4; p < 0,0001), e inversamente con la situación funcional por índice de Barthel (R = ­0,67; p < 0,0001). La edad del paciente (p = 0,03), su vulnerabilidad clínica (p = 0,016) y el deterioro funcional (p < 0,0001) y cognitivo (p = 0,019) predijeron de forma independiente el IEC. Conclusiones. El perfil del CP de los PP se correspondió con mujeres familiares en primer grado de unos 60 años. Más de la tercera parte estaban sobrecargadas; los factores predictores fueron la edad, la vulnerabilidad clínica y el deterioro funcional y cognitivo del PP

Objective. To determine the profile of the main caregiver (MC) and the factors associated with her/his care burden, in a multi-centre cohort of patients with multiple pathologies (PMP). Design. Multi-centre cross-sectional study. Setting. Four health districts in the Virgen del Rocío University Hospitals Health Area, Seville, Spain. Participants. The PMP cohort was created by checking all the patients who satisfied the health department criteria for PMP (2002): patients suffering from chronic diseases in 2 or more of the 7 clinical categories defined. Main measurements. The profile of PMP caregiver was determined for all patients. The caregiver strain index (CSI) was determined by the index of care stress (ICS). Predictive factors were analysed by the Student t, ANOVA, and Pearson's tests. Multivariate analysis was performed by a forward stepwise linear regression model. Results. The interview was attended by 461 (69%) out of 662 eligible PMP. Of these, 293 (63.6%) had an MC whose mean age was 62 (15) years; 80% of them were women. First-degree relatives made up 88% of caregivers, with spouses 49.7% of them (n=146). In 41.5%, the CSI was >7 points (mean CSI was 5.35 [3.5]). This was higher in those caring for PMP with neurological illnesses (7 [3.2 vs 4.5 [3.3]; P=.0001). The CSI was compared directly with the medical vulnerability of the PMP (R=0.37; P=.001), cognitive deterioration on the Pfeiffer scale (PS) (R=0.4; P=.0001), and inversely with functional status on Barthel's scale (BS) (R=­0.67; P=.0001). Patient's age (P=.03), his/her medical vulnerability (P=.016) and functional (P<.0001) and cognitive (P=.019) deterioration were independently associated with the CSI. Conclusions. The profile of the MC of the PMP cohort corresponded mainly to first-degree female relatives around sixty years old. The burden of care was high in more than a third of them. Predictive factors were age, medical vulnerability, and the functional and cognitive deterioration of the PMP