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3.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 46(5): 261-264, sep.-oct. 2011.
Artigo em Espanhol | IBECS | ID: ibc-91130

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 Confiança
4.
Rev Esp Geriatr Gerontol ; 46(5): 261-4, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21944328

RESUMO

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.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/normas , Hospitalização/estatística & dados numéricos , Casas de Saúde/normas , Idoso , Administração de Caso , Auditoria Clínica , Tratamento Farmacológico/economia , Avaliação Geriátrica , Pessoal de Saúde/educação , Humanos
5.
Anesthesiology ; 113(6): 1338-50, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21045639

RESUMO

BACKGROUND: Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population. METHODS: Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed. RESULTS: Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample. CONCLUSION: The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.


Assuntos
Pneumopatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia , Estudos de Coortes , Coleta de Dados/normas , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Pneumopatias/epidemiologia , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , População , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Tamanho da Amostra , Estações do Ano , Espanha/epidemiologia , Resultado do Tratamento
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