Impacto del autocuidado y manejo terapéutico en la utilización de los recursos sanitarios urgentes por pacientes crónicos: estudio de cohortes / Impact of self-management of therapy on use of emergency health care services by patients with chronic diseases: a cohort study

RESUMEN

OBJETIVOS: Determinar si el manejo ineficaz del régimen terapéutico (MIRT) en pacientes crónicos que acuden a urgencias es un predictor de mayor utilización de los recursos sanitarios y de peor calidad de vida. MÉTODO: Estudio de cohortes prospectivas. En 2007 se formaron dos cohortes prospectivas en función de su adherencia o no al tratamiento y fueron seguidas durante 12 meses para evaluar la calidad de vida, la adherencia y el uso de recursos sanitarios. RESULTADOS: De los 302 pacientes incluidos, 167 presentaban MIRT (55,29%). El perfil del paciente era un varón, con hipertensión arterial, polimedicado con baja adherencia terapéutica. El riesgo de reingreso era casi 4 veces mayor en los pacientes expuestos a los 12 meses (OR 3,72, IC al 95% 2,19-6,32; p < 0,0001), evaluados con la herramienta DecaMIRT. Estos pacientes con baja adherencia presentaban una reducción significativa de su calidad de vida superior a 5 puntos (IC 95% 2,60-7,258; p < 0,05), si se comparaban con la cohorte no expuesta. CONCLUSIONES: El manejo efectivo del régimen terapéutico está asociado con la calidad de vida y con el uso que los pacientes crónicos hacen de los recursos sanitarios

ABSTRACT

OBJECTIVE: To determine whether ineffective management of therapeutic regimen is a predictor of frequent use of health care resources and poor quality of life in patients with chronic illnesses. METHODS: Prospective cohort study. Two cohorts were formed in 2007 on the basis of presence or absence of ineffective management. The patients were evaluated for 12 months to assess quality of life, adherence to therapy, and use of health care resources. RESULTS: Of 302 patients included, 167 (55.29%) were in the ineffective-management cohort. In addition to poor adherence to therapy, such patients tended to be men, hypertensive, and on several medications. The risk of readmission in this cohort was nearly 4-fold higher during the 12-month period (odds ratio, 3.72; 95% CI, 2.19-6.32; P<.0001) according to a 10-item scale (DecaMIRT). The patients with low adherence to therapy had quality of life scores that were significantly lower by a mean of more than 5 points (95% CI, 2.60-7.258; P<.05). CONCLUSIONS: In patients with chronic diseases, effective management of therapeutic regimen is associated with quality of life and a different pattern of use of health care resources. The DecaMIRT scale proved valid for measuring adherence to therapy and can help improve how persons with chronic diseases are attended in the emergency department