Efectividad de una intervención educativa enfermera en pacientes crónicos complejos

  1. Rosa María Blanco-López 1
  2. María Dolores Fole-Santalla 1
  3. Mónica Rio-Enríquez 1
  4. María Jesús Quiroga-Mariño 1
  5. Marta Barcón-Pajón 1
  6. Emilio Casariego-Vales 1
  1. 1 Servicio Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
Journal:
Enfermería clínica

ISSN: 1130-8621

Year of publication: 2020

Volume: 30

Issue: 5

Pages: 302-308

Type: Article

DOI: 10.1016/J.ENFCLI.2019.08.008 DIALNET GOOGLE SCHOLAR

More publications in: Enfermería clínica

Abstract

Objective To evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number. Method Pragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts. Results Among the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p=.05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p=.10) were readmitted. Conclusions This study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions.

Bibliographic References

  • M. Fortin, L. Lapointe, C. Hudon, A. Vanasse, A.L. Ntetu, D. Maltais Multimorbidity and quality of life in primary care: a systematic review Health Qual Life Outcomes., 2 (2004), p. 51
  • Zapatero A, Barba R, por el Grupo de Gestión Clínica FEMI. Estudio de un millón de altas hospitalarias en Medicina Interna, 2008
  • M. Matesanz-Fernández, I. Íñiguez-Vázquez, D. Rubal-Bran, S. Pértega-Díaz, J. Conde-Freire, E. Casariego-Vales Multimorbilidad en los servicios médicos hospitalarios: un problema clínico y de gestión Galicia Clin., 73 (Supl. 1) (2012), pp. S15-S19
  • C. Van Walraven, A. Jennings, A.J. Forster A meta-analysis of hospital 30-day avoidable readmission rates J Eval Clin Pract., 18 (2012), pp. 1211-1218
  • I. Ranasinghe, Y. Wang, K. Dharmarajan, A.F. Hsieh, S.M. Bernheim, H.M. Krumholz Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study PLoS Med., 11 (2014), p. e1001737
  • C. Franchi, A. Nobili, D. Mari, M. Tettamanti, C.D. Djade, L. Pasina, et al. Risk factors for hospital readmission of elderly patients Eur J Intern Med., 24 (2013), pp. 45-51
  • D. Etxeberria-Lekuona, J.M. Casas-Fernández de Tejerina, I. Méndez-López, J. Oteiza-Olaso, M. Arteaga-Mazuelas, V. Jarne-Betran Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital Rev Clin Esp., 215 (2015), pp. 9-17
  • S.F. Jencks, M.W. Williams, E.A. Coleman Rehospitalizations among patients in the Medicare fee-for-service program N Engl J Med., 360 (2009), pp. 1418-1428
  • I. Iñiguez-Vázquez, R. Monte-Secades, M. Matesanz-Fernández, E.M. Romay-Lema, D. Rubal-Bran, E. Casariego-Vales Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos Rev Clin Esp., 217 (2017), pp. 309-314
  • A. Jiménez-Puente, J. García-Alegría, J. Gómez-Aracena, L. Hidalgo-Rojas, L. Lorenzo-Nogueiras, J. Crehuet-Navajas Análisis de las causas de reingresos en un hospital de agudos y su evitabilidad potencial Med Clin (Barc)., 118 (2002), pp. 500-505
  • C. Fischer, H.A. Anema, N.S. Klazinga The validity of indicators for assessing quality of care: a review of the European literature on hospital readmission rate Eur J Public Health., 22 (2012), pp. 484-491
  • J. Donzé, D. Aujesky, D. Williams, J.L. Schnipper Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model JAMA Intern Med., 173 (2013), pp. 632-638
  • G.M. Eggert, B. Friedman The need for special interventions for multiple hospital admission patients Health Care Financ Rev., Espc. (Suppl.) (1988), pp. 57-67
  • A.M. Mudge, K. Kasper, A. Clair, H. Redfern, J.J. Bell, M.A. Barras, et al. Recurrent readmissions in medical patients: a prospective study J Hosp Med., 6 (2011), pp. 61-67
  • HealthCare.gov. Delivering better care, lowest costs. Washington, DC: Department of Health and Human Services; 2014
  • I. Schäfer, H. Hansen, G. Schön, W. Maier, S. Höfels, A. Altiner, et al. The German MultiCare-study: Patterns of multimorbidity in primary health care - protocol of a prospective cohort study BMC Health Serv Res., 9 (2009), p. 145
  • A.L. Leppin, M.R. Gionfriddo, M. Kessler, J.P. Brito, F.S. Mair, K. Gallacher, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials JAMA Intern Med., 174 (2014), pp. 1095-1107
  • M. Matesanz-Fernández, R. Monte-Secades, I. Íñiguez-Vázquez, D. Rubal-Bran, H. Guerrero-Sande, E. Casariego-Vales Characteristics and temporal pattern of the readmissions of patients with multiple hospital admissions in the medical department of a general hospital Eur J Intern Med., 26 (2015), pp. 776-781
  • R.J. Lagoe, D. Nanno, M. Luziani Clinical identification of patients readmitted to hospitals: why patients return BMC Res Notes., 6 (2013), p. 419
  • K. Dharmarajan, A.F. Hsieh, Z. Lin, H. Bueno, J.S. Ross, L.I. Horwitz, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia JAMA., 309 (2013), pp. 355-363
  • S. Marusic, N. Gojo-Tomic, V. Erdeljic, V. Bacic-Vrca, M. Franic, M. Kirin, et al. The effect of pharmacotherapeutic counseling on readmissions and emergency department visits Int J Clin Pharm., 35 (2013), pp. 37-44
  • M. Courtney, H. Edwards, A. Chang, A. Parker, K. Finlayson, K. Hamilton Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program J Am Geriatr Soc., 57 (2009), pp. 395-402
  • T.M. Koelling, M.L. Johnson, R.J. Cody, K.D. Aaronson Discharge education improves clinical outcomes in patients with chronic heart failure Circulation., 111 (2005), pp. 179-185
  • J.F. Graumlich, N.L. Novotny, G. Stephen Nace, H. Kaushal, W. Ibrahim-Ali, S. Theivanayagam, et al. Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial J Hosp Med., 4 (2009), pp. 11-19
  • J.M. Cerqueiro, A. González-Franco, M. Montero-Pérez-Barquero, P. Llácer, A. Conde, M.F. Dávila, et al. Reducción de ingresos y visitas a Urgencias en pacientes frágiles con insuficiencia cardíaca: resultados del programa asistencial UMIPIC Rev Clin Esp., 216 (2016), pp. 8-14