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OBJECTIVE: To determine the utility and viability of a chronic care program. DESIGN: Cross-sectional descriptive study with qualitative and quantitative evaluation. SETTING AND PARTICIPANTS: 26 primary care teams (PCT) from the Catalan health service of Gerona. INTERVENTIONS: 20 projects within the program. Start 2011. MAIN OUTCOME MEASURES: The degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]). RESULTS: Evaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. CONCLUSIONS: When assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.
Assuntos
Doença Crônica/terapia , Estudos Transversais , Humanos , Avaliação de Programas e Projetos de Saúde , EspanhaRESUMO
BACKGROUND: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. OBJECTIVE: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. METHODS: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. RESULTS: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. CONCLUSIONS: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.
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COVID-19 , Idoso , Testes Diagnósticos de Rotina , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
INTRODUCTION: Malnourishment in the geriatric population is a common and serious situation that is often undiagnosed. This study aimed to compare nutritional status, measured by the Mini Nutritional Assessment (MNA), in the geriatric population institutionalized in residential centres and those included in the In-Home Assistance Program (IHAP) overseen by two urban-rural primary care teams, as well as to identify the factors related to the risk of malnourishment. MATERIAL AND METHODS: We performed a cross-sectional estimation study of the prevalence of malnourishment or risk of malnourishment according to different explanatory variables by means of a logistics model. A total of 102 institutionalized patients and 170 patients included in the IHAP aged more than 65 years old were analyzed. RESULTS: No significant differences were found between institutionalized patients and those included in the IHAP by age, sex or pharmaceutical consumption, but differences were found in typology and the Barthel test. Chronic disease predominated in patients assisted at home (62.4%) and dementia in those who were institutionalized (39.2%). According to the MNA, malnourishment or risk of malnourishment was found in 67.6% of patients in the IHAP and in 93.1% of institutionalized patients. When adjustments were made for age and typology, correct nutritional status was 4.35 times more frequent in IHAP patients than in institutionalized patients. CONCLUSIONS: The profile of patients at greater risk of compromised nutritional status or with established malnourishment includes those that are institutionalized, older than 74 years and/or with dementia. These patients should receive corrective or preventative measures for malnourishment.