Eva Abad-Corpa

Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol

AIM To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow-up planning for primary care patients with chronic obstructive pulmonary disease. BACKGROUND Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge. METHODS A quasi-experimental design will be adopted, with a control group and pseudo-randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary-level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. DISCUSSION The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses.

Efficacy of a self-management plan in exacerbations for patients with advanced COPD.

Background Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD. Methods Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality. Results After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191). Conclusion The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.

Effectiveness of participatory-action-research to put in practice evidence at a nursing onco-hematology unit

Correspondencia: Eva Abad-Corpa Direccion General de Planificacion Ordenacion Sanitaria y Farmaceutica e Investigacion Consejeria de Sanidad y Politica Social de Murcia C/ Pinares 6, 4a planta. 30001 Murcia. Espana E-mail: evaabadcorpa@ono.com; eva.abad@carm.es Evaluacion de la efectividad de la implantacion de evidencias mediante una investigacion-accion-participante en una unidad de enfermeria oncohematologica1O objetivo deste estudo foi avaliar a efetividade da aplicacao de evidencias pela pesquisa-acao-participante (PAR). Como metodo usou-se o desenho quase-experimental prospectivo, com dois grupos nao equivalentes e concorrentes (2006-2008), em uma unidade de enfermagem para transplante de medula ossea de hospital terciario espanhol. A intervencao estudada foi a integracao de evidencias pela PAR. As variaveis dependentes estudadas foram: o desempenho profissional e os resultados de saude nos pacientes (area psicoemocional e efeitos adversos). Recrutaram-se 125 pacientes (Grupo 1=56, Grupo 2=69). Pode-se observar pelos resultados melhora significativa no segundo grupo, na qualidade dos registros de enfermagem na avaliacao de sinais e sintomas do paciente. Na area psicoemocional, o ajuste psicossocial do paciente melhorou significativamente, porem, nenhuma mudanca foi observada na sobrecarga do cuidador ou satisfacao do paciente. Em relacao aos efeitos adversos, tanto o bloqueio quanto a infeccao relacionada ao cateter melhoraram significativamente, mas nao foi encontrada nenhuma diferenca na dor nem na mucosite. Conclui-se que a PAR tem servido para apresentar evidencias e melhorar os resultados de saude.

Estudio descriptivo sobre el perfil socio-demográfico y clínico del paciente con enfermedad pulmonar obstructiva crónica

OBJECTIVE To find out the socio-demographic and clinical profile of the patient with Chronic Obstructive Pulmonary Disease (COPD): characteristics, state of health, situation of disease and social resources. METHOD A descriptive, longitudinal and prospective study, in the Morales Meseguer and Reina Sofía Hospitals in Murcia (Spain), was performed between June 2007 and April 2008. The inclusion criteria was hospital admission due to COPD and patients with cognitive deterioration, a hospital stay > 30 days or < 2 days, or were institutionalised, were excluded. Socio-demographic, state of health and social variables were collected using the patients clinical history and an interview during hospital stay and at discharge. The descriptive statistical analysis was carried out using SPSS v.15. RESULTS A total of 143 patients were studied, of which 90.2% were males who had a mean age of 72.76 ± 8.04 years, 95.1% were in an inactive work situation and had a mean score on the social problem scale of 8.08 ± 2.1. Most were in a fragile state (71.3%), approximately half (44.8%) suffered heart disease as the main co-morbidity factor, and the impact of the disease on quality of life was 55.1 ± 19.01. The level of knowledge on the therapeutic regime was 3.13 ± 0.7. A total of 72% were independent for carrying out Basic Activities of Daily Living (BADL) after hospital discharge. CONCLUSIONS Most of the population that suffers from COPD were elderly males, who were retired without social problems, with a high percentage of co-morbidity, an intermediate alteration in their quality of life, having a moderate level of knowledge about the therapeutic regime and were independent for BADL, but fragile.

Avaliação da efetividade da aplicação de evidências por meio de pesquisa-ação-participante em uma unidade de enfermagem hematológica

Correspondencia: Eva Abad-Corpa Direccion General de Planificacion Ordenacion Sanitaria y Farmaceutica e Investigacion Consejeria de Sanidad y Politica Social de Murcia C/ Pinares 6, 4a planta. 30001 Murcia. Espana E-mail: evaabadcorpa@ono.com; eva.abad@carm.es Evaluacion de la efectividad de la implantacion de evidencias mediante una investigacion-accion-participante en una unidad de enfermeria oncohematologica1O objetivo deste estudo foi avaliar a efetividade da aplicacao de evidencias pela pesquisa-acao-participante (PAR). Como metodo usou-se o desenho quase-experimental prospectivo, com dois grupos nao equivalentes e concorrentes (2006-2008), em uma unidade de enfermagem para transplante de medula ossea de hospital terciario espanhol. A intervencao estudada foi a integracao de evidencias pela PAR. As variaveis dependentes estudadas foram: o desempenho profissional e os resultados de saude nos pacientes (area psicoemocional e efeitos adversos). Recrutaram-se 125 pacientes (Grupo 1=56, Grupo 2=69). Pode-se observar pelos resultados melhora significativa no segundo grupo, na qualidade dos registros de enfermagem na avaliacao de sinais e sintomas do paciente. Na area psicoemocional, o ajuste psicossocial do paciente melhorou significativamente, porem, nenhuma mudanca foi observada na sobrecarga do cuidador ou satisfacao do paciente. Em relacao aos efeitos adversos, tanto o bloqueio quanto a infeccao relacionada ao cateter melhoraram significativamente, mas nao foi encontrada nenhuma diferenca na dor nem na mucosite. Conclui-se que a PAR tem servido para apresentar evidencias e melhorar os resultados de saude.

Evaluación de la efectividad de la implantación de evidencias mediante una investigación-acción-participante en una unidad de enfermería oncohematológica

Correspondencia: Eva Abad-Corpa Direccion General de Planificacion Ordenacion Sanitaria y Farmaceutica e Investigacion Consejeria de Sanidad y Politica Social de Murcia C/ Pinares 6, 4a planta. 30001 Murcia. Espana E-mail: evaabadcorpa@ono.com; eva.abad@carm.es Evaluacion de la efectividad de la implantacion de evidencias mediante una investigacion-accion-participante en una unidad de enfermeria oncohematologica1O objetivo deste estudo foi avaliar a efetividade da aplicacao de evidencias pela pesquisa-acao-participante (PAR). Como metodo usou-se o desenho quase-experimental prospectivo, com dois grupos nao equivalentes e concorrentes (2006-2008), em uma unidade de enfermagem para transplante de medula ossea de hospital terciario espanhol. A intervencao estudada foi a integracao de evidencias pela PAR. As variaveis dependentes estudadas foram: o desempenho profissional e os resultados de saude nos pacientes (area psicoemocional e efeitos adversos). Recrutaram-se 125 pacientes (Grupo 1=56, Grupo 2=69). Pode-se observar pelos resultados melhora significativa no segundo grupo, na qualidade dos registros de enfermagem na avaliacao de sinais e sintomas do paciente. Na area psicoemocional, o ajuste psicossocial do paciente melhorou significativamente, porem, nenhuma mudanca foi observada na sobrecarga do cuidador ou satisfacao do paciente. Em relacao aos efeitos adversos, tanto o bloqueio quanto a infeccao relacionada ao cateter melhoraram significativamente, mas nao foi encontrada nenhuma diferenca na dor nem na mucosite. Conclui-se que a PAR tem servido para apresentar evidencias e melhorar os resultados de saude.