Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study.

BACKGROUND: There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. DESIGN: Multicentre randomized clinical trial with an intervention and a control group. SETTING: 12 primary care centres in the province of Tarragona (Spain). SUBJECTS OF STUDY: 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. INTERVENTION: Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant), comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. MEASUREMENTS: Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. MAIN VARIABLES: Smoking cessation at 12 months. ANALYSIS: Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. EXPECTED RESULTS: Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the intervention group than in the control group. DISCUSSION: Application of a motivational intervention based on structured information about spirometry results, improved abstinence rates among smokers seen in actual clinical practice conditions in primary care. TRIAL REGISTRATION: ClinicalTrial.gov, number NCT01194596.

Nursing workload predictors in Catalonia (Spain): a home care cohort study

Objective: To identify the characteristics of chronic patients and their environment in order to predictthe nursing workload required 1 year after their inclusion in a home care program.Methods: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain)with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected fromeach patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer,Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services,self-perceived health (SF-12) and the number of health worker visits.Results: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender(IRR = 1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR = 1.65, 95%CI: 1.29-2.13), decubitusulcers (IRR = 4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR = 1.65, 95%CI:1.31-2.07). In contrast, patients with major cognitive impairment (IRR = 0.78, 95%CI: 0.63-0.98) had alower probability of receiving nursing visits at home.Conclusions: Workload can be predicted by patients’ clinical characteristics. The positive correlation ofworkload with variables related to disease severity and the negative correlation with variables relatedto cognitive impairment show that home care nursing in Catalonia is basically demand-oriented (AU)

Objetivo: Identificar las características basales de los pacientes crónicos y su entorno que predicen la cargade trabajo de enfermería durante el a˜no siguiente a su inclusión en un programa de atención domiciliaria(ATDOM).Métodos: Estudio longitudinal realizado en 72 equipos de atención primaria de salud en Catalu˜na.Seguimiento durante un a˜no de 1068 pacientes de ATDOM mayores de 64 a˜nos de edad. Variables recogidas:nivel de salud y situación social (test de Charlson, Barthel, Pfeiffer, Braden y Gijón); sobrecarga delcuidador (Test de Zarit); ingresos hospitalarios y visitas a urgencias; estado subjetivo de salud (SF-12);visitas de los profesionales de salud.Resultados: Los pacientes recibieron 7,2 (DE: 10,4) visitas anuales de su enfermera habitual. Observamosque tienen más riesgo de recibir visitas de enfermería los pacientes varones (IRR = 1,42, IC95%: 1,20-1,67), con dependencia para las actividades de la vida diaria (IRR = 1,65, IC95%: 1,29-2,13), afectados porúlceras por decúbito (IRR = 4,03, IC95%: 2,27-7,14) y que precisaron servicios de atención de urgencia adomicilio (IRR = 1,65, IC95%: 1,31-2,07). Por otro lado, los pacientes con deterioro cognitivo importantetienen menos probabilidad de recibir visitas de su enfermera (IRR = 0,78, IC95%: 0,63-0,98).Conclusiones: Las características clínicas de los pacientes permiten predecir la carga de trabajo de enfermería.Esta relación positiva de la carga de trabajo con las variables relacionadas con la gravedad de laenfermedad y la relación negativa con el deterioro cognitivo muestra que la enfermería domiciliaria enCataluña está básicamente orientada a la demanda(AU)

Nursing workload predictors in Catalonia (Spain): a home care cohort study.

OBJECTIVE: To identify the characteristics of chronic patients and their environment in order to predict the nursing workload required 1 year after their inclusion in a home care program. METHODS: A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain) with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected from each patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer, Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services, self-perceived health (SF-12) and the number of health worker visits. RESULTS: Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD 13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender (IRR=1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR=1.65, 95%CI: 1.29-2.13), decubitus ulcers (IRR=4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR=1.65, 95%CI: 1.31-2.07). In contrast, patients with major cognitive impairment (IRR=0.78, 95%CI: 0.63-0.98) had a lower probability of receiving nursing visits at home. CONCLUSIONS: Workload can be predicted by patients' clinical characteristics. The positive correlation of workload with variables related to disease severity and the negative correlation with variables related to cognitive impairment show that home care nursing in Catalonia is basically demand-oriented.

Traslados en enfermería: Movilidad voluntaria en clave migratoria / Nursing relocation: voluntary nurse migration

En el Instituto Catalán de la Salud (ICS) la selección de personal fijo se efectúacon carácter general mediante el sistema de concurso oposición y la fasede movilidad voluntaria o traslados, que permite que un profesional estatutariofijo se traslade a otra plaza, dentro de la misma categoría y especialidad,en el conjunto de servicios de salud del Sistema Nacional de Salud (SNS).Excepto para las matronas, las enfermeras del trabajo, y en algunas ComunidadesAutónomas para enfermeras de salud mental, el concurso de movilidadvoluntaria no oferta puestos de enfermeras especialistas.Desde el marco teórico de la Geografía Humana/Demografía se analiza el fenómenode la movilidad voluntaria de los profesionales enfermeros en clavemigratoria, con el objetivo de visualizar las repercusiones estructurales ygrupales que este flujo o migración puede tener dentro del sistema sanitario.En la convocatoria de movilidad voluntaria P-2007, 1.043 enfermeras aspirabanal traslado, el 57,8% provenía de ámbito hospitalario y el númerode plazas ofertadas para enfermeras en Atención Primaria (AP) fue de 215.Un 73% fueron ocupadas por enfermeras que provenían de equipos de APy un 27% de hospitales.Los traslados a AP, entendidos como migraciones laborales, tienen: a) efectospositivos: provocan un descenso del paro en el lugar de partida, aumentanel capital humano y aportan un conocimiento diferente y enriquecedor,con nuevas ideas; y b) efectos negativos: carencia de habilidadesespecíficas, aumento de la carga laboral de profesionales expertos y sentimientode invasión cultural, junto al envejecimiento de la población receptora,al contrario de lo que ocurre en otras migraciones laborales, que no estánsiendo suficientemente tenidos en cuenta cuando se convoca un concursode movilidad voluntaria o traslado (AU)

At the Catalan Health Institute (ICS) the selection of permanent staff membersis carried out within a general framework by means of a public examinationand subsequent voluntary mobility or relocation which allows apermanently employed statutory professional to relocate to another post, withinthe same category and specialty, within the portfolio of services of theNational Health System (SNS).The voluntary mobility call does not offer specialised nurse positions, exceptin the case of midwives, occupational nurses and, in some AutonomousCommunities, mental health nurses.The phenomenon of the voluntary migration of nursing professionals isanalysed within the framework of Human Geography/Demography theory,with the aim of determining the structural and group consequences that thisflow or migration can have within the health care system.In the call for voluntary mobility P-2007, 1,043 nurses hoped for relocation,57,8% worked in the hospital setting and the number of positions offered tonurses in Primary Care (PC) was 215. 73% of these positions were occupiedby nurses from PC teams and 27% were filled by nurses working in hospitals.Relocations to PC, understood as occupational migrations, have: a) positiveeffects: they produce a decrease in unemployment at the point of origin,increase human capital and provide different and enriching knowledge,with new ideas; and b) negative effects: lack of specific skills, increasedwork load of expert professionals and a feeling of cultural invasion, in additionto the ageing of the recipient population, contrary to what occurs inother occupational migrations, which are not being sufficiently taken intoaccount when there is a call for voluntary mobility or relocation (AU)

[Health problems also explain social services use in home care]. / Los problemas de salud también explican la utilización de servicios sociales en atención domiciliaria.

OBJECTIVE: To identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law. DESIGN: Cross-sectional study. SETTING: 72 primary health care teams in Catalonia. PATIENTS: Patients over 64 years old with chronic diseases in home care programmes in Catalonia. MEASUREMENTS: Health status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital. RESULTS: A total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care. CONCLUSIONS: To be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care.

Los problemas de salud también explican la utilización de servicios sociales en atención domiciliaria / Health problems also explain social services use in home care

Objetivo: identificar las variables relacionadas con el hecho de recibir servicios sociales de carácter público o privado antes de la implantación de la Ley de Dependencia en pacientes recluidos en sus domicilios. Diseño: estudio descriptivo transversal. Emplazamiento: 72 equipos de atención primaria de Cataluña (EAP). Participantes: pacientes mayores de 64 años, no institucionalizados atendidos por un programa de atención domiciliaria de los EAP. Mediciones principales: de cada paciente se registraron: comorbilidad, estado funcional, estado cognitivo, si tenía úlceras por presión, salud subjetiva, valoración social, utilización de servicios sociales y sanitarios formales e informales, sobrecarga del cuidador, ingresos en residencias, hospitales o urgencias, además del número de visitas de profesionales santiarios. Resultados: participan 1.068 pacientes, el 46,8% recibe algún servicio social. Las variables relacionadas con la prestación de servicios sociales son: el grado de dependencia (Barthel), las úlceras por presión y recibir rehabilitación a domicilio. El test de Barthel está firmemente asociado a la problemática social (Gijón), carecer de cuidador informal, más de dos visitas de médico de familia y tener sanidad privada adicional. Conclusiones: para ser más equitativa, la valoración de las prestaciones de la Ley de Dependencia debería considerar también el estado de salud. Antes de la aplicación de esta ley se intuye una dificultad de acceso a los servicios sociales formales para las clases medias que no acceden a las prestaciones públicas ni pueden pagarlas. Las prestaciones sociales son todavía una alternativa a la atención familiar(AU)

Objective: To identify which social and health variables are associated with receiving social services in patients included in home care programmes with the implementation of the Dependence Law. Design: Cross-sectional study. Setting: 72 primary health care teams in Catalonia. Patients: Patients over 64 years old with chronic diseases in home care programmes in Catalonia. Measurements: Health status variables: Charlson, Barthel, Pfeiffer, Braden and Gijon, data from their carer (Zarit), self perception of health (SF-12), health professional visits, as well as: emergency visits, temporary admissions, and final results such as death or definitive admission in a nursing home or a hospital. Results: A total of 1068 patients were included, 46.8% of the patients received some kind of social service, public or private. We observed that the variables related to receive some kind of social services are: high dependence (Barthel test), pressure sores and home care rehabilitation. Barthel test is highly associated with having social problems (Gijon test), living without an informal carer, more than 2 GP visits and having additional private health care. Conclusions: To be more fair, the evaluation of the provisions of the Dependence Law should also consider the health status of the patient. With the implementation of this law we can observe difficulties in access to social services for middle class patients. These patients do not have access to public social assistance and cannot pay for a private one. Social services are still an alternative to family care(AU)