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Vol. 34. Issue 11.
Pages 541-546 (December 1998)
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Vol. 34. Issue 11.
Pages 541-546 (December 1998)
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Mejor en casa: un programa de asistencia continuada para los pacientes con enfermedad respiratoria crónica avanzada
Better at home: a continuous health care program for patients with advanced chronic respiratory disease
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R. Güell*, A. González, F. Morante, M. Sangenis, C. Sotomayor, C. Caballero, J. Sanchís
Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Barcelona
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El objetivo del estudio fue analizar el efecto de una asistencia continuada sobre la frecuencia de reingresos de los pacientes con enfermedad respiratoria crónica avanzada. El estudio, prospectivo, incluyó 26 pacientes (16 con enfermedad pulmonar obstruida crónica, siete con bronquiectasias y tres con paquipleuritis) ingresados, como mínimo, tres veces en el año previo. Los pacientes se distribuyeron en tres grupos de asistencia: grupo A, de control ambulatorio, formado por 8 pacientes que podían desplazarse al hospital para un control mensual en la consulta externa; grupo B, de fisioterapia ambulatoria, con 10 pacientes que podían desplazarse al hospital y precisaban fisioterapia respiratoria (una sesión semanal de fisioterapia en grupo), y grupo C, de asistencia a domicilio, con 8 pacientes que no podían desplazarse al hospital (una visita semanal o quincenal en el domicilio). Todos ellos disponían de un teléfono de contacto con el equipo del programa. Los valores medios de función pulmonar para todo el grupo fueron: FVC 40 (11)%, FEV1 23 (7)% del valor de referencia, PaO2 55 (7), y PaCO2 55 (10) mmHg. Se observó una disminución significativa del número de ingresos (79 frente a 18; p < 0,0001). Esta reducción se produjo tanto en el primero como en el segundo semestre del año y en los 3 grupos de asistencia: grupo A: de 25 a 2; grupo B: de 28 a 8, y grupo C, de 26 a 8 (p < 0,001). Se contabilizó una reducción de 22.751.402 pías. de gasto sanitario en relación al año previo. En conclusión, los datos indican que una asistencia especializada, continuada y personalizada consigue reducir los repetidos ingresos hospitalarios de los pacientes con enfermedad respiratoria crónica avanzada y el gasto generado, sin necesidad de asistencia domiciliaria a todos ellos.

Palabras clave:
Enfermedad respiratoria crónica
Reingresos hospitalarios
Asistencia a domicilio

The objective of this study was to analyze the effect of continuous health care on the frequency of readmissions of patients with advanced chronic respiratory disease. The study was prospective, enrolling 26 patients (16 with COPD, 7 with bronchiectasis and 3 with pachypleuritis) who had been admitted at least 3 times within the past year. The patients were assigned to 3 groups: group A was the ambulatory monitoring group, with 8 patients who were able to travel to the hospital for monthly outpatient checkups; group B was the ambulatory pulmonary rehabilitation group, with 10 patients who were able to travel to the hospital and who needed rebreathing training (one weekiy group session); and group C was the home care group, with 8 patients who were unable to travel to the hospital and who received weekly or biweekiy house calis. All patients had telephone contact with the program team. Mean lung function valúes for the whole population were FVC 40 (11)%, FEV1 23 (7)% of reference, PaO2 55 (7) and PaCO2 55 (10) mmHg. A significant decrease in number of admissions (79 versus 18, p < 0.0001) was observed in both the first and second halves of the year in all three treatment groups: A, 25 to 2; B, 28 to 8; and C, 26 to 8 (p < 0.001). The reduction in health care costs over the previos year's expenditure was calculated to be 22,751,402 pesetas. We conclude that specialized health care that is continuous and personalized reduces the number of hospital readmissions of patients with advanced chronic respiratory disease. Moreover, the overall cost of care, without the need to make house calis to all patients.

Key words:
Chronic respiratory disease
Hospital readmissions
Home health care
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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