RESUMO
Objetivos. Este estudio describe los resultados de un programa de intervención asistencial en residencias geriátricas (RG) y su repercusión en las visitas a urgencias, ingresos hospitalarios urgentes y gasto farmacéutico. Material y métodos. Intervención comunitaria no aleatorizada en RG con un grupo control. Se implanta progresivamente desde 2007 a 2009 en 10 RG (857 plazas) que participaron voluntariamente. Formaron el grupo control 14 RG (1.200 plazas), las que declinaron participar y las que no estaban asignadas a nuestros centros de salud. La intervención consistió en la valoración geriátrica integral y visitas de seguimiento por personal especializado, revisión y adecuación del tratamiento farmacológico, gestión de casos y formación del personal. Resultados. En las RG intervenidas la frecuentación a urgencias disminuyó pasando de1.165 (IC 95% 1.100-1.240) en 2006 a 674 (IC 95% 620-730) en 2009, mientras que en las no intervenidas se incrementó de 1.071 (IC 95% 1.020-1.130) a 1246 (IC 95% 1.190-1.310). Los ingresos hospitalarios urgentes se redujeron de 48,4% (IC 95% 45-52) en 2006 a 32,1% (IC 95% 29-35) en 2009, mientras que en el grupo control se incrementó de 43,5% (IC 95% 41-46) a 55,8% (IC 95% 53-59). Se redujo un 9,0% el gasto de farmacia en las RG intervenidas frente a un incremento del 11,9% en las RG control. Conclusiones. El programa de intervención ha demostrado ser efectivo para reducir la frecuentación hospitalaria y de urgencias en los pacientes institucionalizados y permite racionalizar los costes de farmacia(AU)
Objectives. This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure. Material and methods. This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training. Results. In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165 (95%CI 1100-1240]) in 2006 to 674 (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246 (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group. Conclusions. The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs(AU)
Assuntos
Humanos , Masculino , Feminino , Estâncias para Tratamento de Saúde/legislação & jurisprudência , Estâncias para Tratamento de Saúde/normas , Ensaio Clínico , Investimentos em Saúde/tendências , Saúde do Idoso Institucionalizado , Hospitais Geriátricos , Administração de Serviços de Saúde , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Intervalos de ConfiançaRESUMO
OBJECTIVES: This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure. MATERIAL AND METHODS: This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training. RESULTS: In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165 (95%CI 1100-1240]) in 2006 to 674 (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246 (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group. CONCLUSIONS: The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs.
