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Rodrigo-Troyano A, Melo V, Marcos P, Laserna E, Peiro M, Suarez-Cuartin G, Perea L, Feliu A, Plaza V, Faverio P, Restrepo MI, Anzueto A, Sibila O. Pseudomonas aeruginosa in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study. Respiration 2018; 96:417-424. [DOI: 10.1159/000490190] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
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Solanes I, Bolíbar I, Llauger MA, Peiro M, Valverde P, Fraga M, Medrano C, Bigorra T, Freixas M, Ligüerre I, Pou MA, Domínguez L, Valero C, Solà J, Giner J, Plaza V. [Is the introduction of clinical management programs for patients with chronic obstructive pulmonary disease useful? Comparison of the effectiveness of two interventions on the clinical progress and care received]. Aten Primaria 2017; 50:184-196. [PMID: 28735722 PMCID: PMC6837048 DOI: 10.1016/j.aprim.2017.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/02/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objetivo Evaluar la efectividad de dos programas de gestión en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Diseño Estudio de diseño cuasi-experimental para evaluar la efectividad de dos intervenciones (I1, I2) para la asistencia de pacientes con EPOC, tras un seguimiento medio de 31,2 meses. Emplazamiento Centros de atención primaria de dos áreas sanitarias de Barcelona y sus hospitales de referencia. Participantes Pacientes EPOC seleccionados por muestreo aleatorio simple en los que constara algún código correspondiente a EPOC. Intervenciones I1: Programa de gestión integral que optimizaba y coordinaba los recursos. Se hizo formación y control de calidad de la espirometría. I2: Intervenciones aisladas, como el call-center. Compartían circuitos asistenciales y la historia clínica informatizada. Mediciones principales variables de función pulmonar, gravedad, uso de inhaladores, estilos de vida, calidad de vida y exacerbaciones. Resultados De los 393 pacientes evaluados al inicio, 120 y 104 (I1 e I2, respectivamente) realizaron la evaluación final. Con la I1 hubo una reducción de los pacientes fumadores (p = 0,034). En ambos grupos, la función pulmonar y la calidad de vida se mantuvieron y la disnea mostró un leve empeoramiento. El correcto uso de inhaladores aumentó, aunque solo alcanzó el 48 y el 61% con la I1 e I2, respectivamente. El porcentaje de pacientes exacerbados disminuyó con la I1 (respecto I2 [p < 0,001]) y el de ingresos hospitalarios por exacerbación disminuyó con la I2 (respecto I1 [p < 0,003]). Conclusiones Ambas intervenciones consiguieron mejoras relevantes y el no empeoramiento global de una enfermedad crónica y progresiva como es la EPOC.
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Affiliation(s)
- Ingrid Solanes
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España.
| | - Ignasi Bolíbar
- Servicio de Epidemiologia Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Ciber de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | | | - Meritxell Peiro
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | - Pepi Valverde
- EAP Gaudí, Consorci Sanitari Integral, Barcelona, España
| | - Mar Fraga
- EAP Xafarinas, Institut Català de la Salut, Barcelona, España
| | | | - Teresa Bigorra
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Iskra Ligüerre
- Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | | | | | - Carles Valero
- Unitat d'Avaluació de Sistemes d'Informació i Qualitat, Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Judit Solà
- Departamento de Epidemiologia Clínica y Salud Pública. Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jordi Giner
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | - Vicente Plaza
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
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Bolíbar I, Plaza V, Llauger M, Amado E, Antón PA, Espinosa A, Domínguez L, Fraga M, Freixas M, de la Fuente JA, Liguerre I, Medrano C, Peiro M, Pou M, Sanchis J, Solanes I, Valero C, Valverde P. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease. BMC Public Health 2009; 9:68. [PMID: 19239679 PMCID: PMC2661072 DOI: 10.1186/1471-2458-9-68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. METHODS/DESIGN A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. DISCUSSION The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
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Affiliation(s)
- Ignasi Bolíbar
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | | | - Ester Amado
- Àmbit Barcelona. Catalan Health Institute, Barcelona, Spain
| | - Pedro A Antón
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ana Espinosa
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Leandra Domínguez
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Mar Fraga
- EAP Xafarinas. Catalan Health Institute, Barcelona, Spain
| | | | | | - Iskra Liguerre
- CAP Sant Andreu, Catalan Health Institute, Barcelona, Spain
| | | | - Meritxell Peiro
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Mariantònia Pou
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Joaquin Sanchis
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ingrid Solanes
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Carles Valero
- SAP Dreta, Catalan Health Institute, Barcelona, Spain
| | - Pepi Valverde
- EAP Gaudí (CAP Sagrada Familia), Consorci Sanitari Integral, Barcelona, Spain
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Bianchi Cardona A, Vidal Sans J, Fernández-Llamazares Rodríguez J, Martinez Sarabia A, Peiro M, Navarrete M. [Gastrocystoplasty. Experimental technic of urinary diversion]. Actas Urol Esp 1980; 4:77-82. [PMID: 7386244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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