University of Cantabria, Spain
Title: The chronic complex patient in Cantabria and Balearic Island (Spain). An Observational Study
Francisco Jose Amo Setien gained a PhD in Health Sciences (University of Cantabria, UC) in 2017, holds an inter-university Master's Degree in "Genetic, nutritional and environmental conditioning factors of growth and development" (UC) and a Nursing Degree (UC). Francisco Jose has gained research experience in the field of nutrition, obesity in children and adolescents with intellectual disabilities, as well as in health related quality of life in patients with chronic diseases, and he has been a full-time teaching assistant in the area of community health in the nursing department of the University of Cantabria since 2014.
Chonicity management is the greatest challenge that the Spanish national health system faces, having to invest 80% of health expenditure to deal with this problem. Complex chronic patients (CCPs) are those patients in which several chronic pathologies coexist with frequent decompensation and high risk of functional loss. CCPs represent between 3-5% of the Spanish population and consume a high percentage of the resources. Objective: To describe the level of dependence and cognitive impairment experienced by chronic complex patients in the urban area of Santander (Cantabria) and Palma (Balearic Islands). Methods: A multicenter, cross-sectional study involving over 18-year-old CCPs located at 3-4 level of the risk pyramid in the care model to chronicity. They are located in the urban area of Primary Care in Santander (Cantabria) and Palma (Balearic Islands). Barthel Index was used to assess dependence and cognitive deterioration was assessed through the Pfeiffer test. Results: 20 Health Centers from Santander (n = 2885) and 16 from Palma (n = 1631) participated in the study. The average age of the selected chronic patients was 77 years (SD = 12.3). 27.4% presented moderate, severe or total dependence and 23.6% moderate or significant cognitive impairment. A linear relationship was observed between the scores in the Pfeiffer test and the Barthel index (r=-0.47, p <0.001). The hospital admission rate correlated with the score in the Pfeiffer test (r = 0.2, p <0.001) and in the Barthel index (r = -0.19, p <0.001). Conclusions: Age, dependency level, cognitive deterioration and hospital admission rate are intimately related in complex chronic patients. Therefore, it is important to continue promoting care models aimed at reducing dependency.
Abstract 2: A systematic review and meta-analysis of nursing interventions in patients with chronic diseases
Nurses often perform interventions aimed at improving the health-related quality of life (HRQOL) in patients with chronic diseases. However, the amount of information generated, sometimes contradictory, makes it difficult to interpret the results. This systematic review allows empirical evidence to be summarized. Thus, the purpose of this study is to determine, through a systematic review and a meta-analysis, the characteristics of the nursing interventions, performed in people/patients over 18 years old with chronic diseases, which involve an improvement in their HRQOL. A literature search was performed in six electronic databases (Pubmed, Scopus, WOS, CINAHL, Web of Science and Cochran) from September until December 2017. Also, bibliographies of relevant papers and publications were hand searched. Study Selection: Randomized controlled trials (RCTs) and cluster-RCTs, with at least two groups of patients in which a nurse was involved. Data Extraction and Synthesis: Two authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies being solved through discussion. In the meta-analysis, Effect Sizes (ESs) were calculated for each outcome by calculating the standardized mean change for each sample. Findings: This systematic review synthesizes data from 38 studies, published between 2003 and 2015, that provided a sample of 6480 people with a mean age of 68.4 years (SD = 8.7). In 60.6% of the interventions a single component was used, being education the one most commonly used. 72.5% of the interventions were not based on a theory. The duration of the interventions ranged from 4-104 weeks, with a mean of 12 sessions and 54.2 minutes/session. SF-36 questionnaire was the most often used to evaluate HRQOL. After the intervention, most of the studies showed a slight HRQOL improvement (ES = 0.1) in the intervention group. Conclusions: Nurses interventions had a little, but significant beneficial effect on HRQOL.