The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain
DOI:
https://doi.org/10.23938/ASSN.0119Keywords:
"Continuity of patient care". "Primary Health Care". "Home Care Services, Hospital-Based". "Self-care". "Outpatients"Abstract
Background. Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. This study estimates the effectiveness of different tools for integrated care in Spain.
Methods. We performed a systematic review of articles using MEDLINE (last search July31st, 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment.
Results. Twenty studies met the criteria for the systematic review. Interventions included were hospital-at home (four studies, 455 patients), outpatient clinic by videoconference (three studies, 2438 patients), nurse navigator (four studies, 1051 patients), self-care improvement (four studies, 1291 patients), at-home health monitoring (three, 162), health apps (two, 225) and medical reconciliation (one, 172). Hospital-at-home, nurse navigator or self-care improvement reduced readmission rate in older patients, heart failure (HF) or chronic obstructive pulmonary disease (COPD). Self-care improvement and nurse navigator reduced mortality rate in HF. Hospital-at-home reduced hospital stay in COPD. Self-care improvement reduced outpatient visits in asthma patients. Outpatient video by videoconference reduced time to diagnosis and treatment in rural areas. The quality of the evidence ranged from low to very low for all the outcomes because it was based in double or triple downgraded randomized trials.
Conclusion. The implementation of tools for integrated care in Spain improved some outcomes of relevance in patients with chronic conditions, although evidence is low. Self-care improvement stood out due to the improvements made.
Keywords. Continuity of patient care. Primary Health Care. Home Care Services. Hospital-Based. Self-care. Outpatients.
Downloads
References
GARCÍA-GONZÁLEZ JM. ¿Por qué vivimos más? Descomposición por causa de la esperanza de vida española, 1980 a 2009. Rev Esp Investig Sociol 2014; 148: 39-60.
HARO JM, TYROVOLAS S, GARIN N, AZ-TORNE C, CARMONA L, SANCHEZ-RIERA L et al. The burden of disease in Spain: results from the global burden of disease study 2010. BMC Med 2014; 12: 236.
PRUITT SD, EPPING-JORDAN JE. Preparing the 21st century global healthcare workforce. BMJ 2005; 330: 637-639.
LAINE C, DAVIDOFF F. Patient-centered medicine. A professional evolution. JAMA 1996; 275: 152-156.
GIGERENZER G, MUIR-GRAY JA. Launching the Century of the Patient. In: Gigerenzer G, Muir-Gray JA, editores. Better doctors, better patients, better decisions: envisioning health care 2020. Cambridge: MIT Press 2011; 3-28.
CRAWLEY L. Evidence-based medicine: a new paradigm for the patient. JAMA 1993; 269: 1253.
COULTER A. Patients' views of the good doctor. BMJ 2002; 325: 668-669.
JUNG HP, WENSING M, GROL R. What makes a good general practitioner: do patients and doctors have different views? Br J Gen Pract 1997; 47: 805-809.
KRIPALANI S, LEFEVRE F, PHILLIPS CO, WILLIAMS MV, BASAVIAH P, BAKER DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007; 297: 831-841.
HARDWICK R, PEARSON M, BYNG R, ANDERSON R. The effectiveness and cost-effectiveness of shared care: protocol for a realist review. Syst Rev 2013; 2: 12. doi: 10.1186/2046-4053-2-12.
GIONFRIDDO MR, LEPPIN AL, BRITO JP, LEBLANC A, BOEHMER KR, MORRIS MA et al. A systematic review of shared decision making interventions in chronic conditions: a review protocol. Syst Rev 2014; 3: 38. doi: 10.1186/2046-4053-3-38.
MUELLER SK, SPONSLER KC, KRIPALANI S, SCHNIPPER JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 2012; 172: 1057-1069.
MEKONNEN AB, MCLACHLAN AJ, BRIEN JA. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther 2016; 41: 128-144.
MIDLOV P, DEIERBORG E, HOLMDAHL L, HOGLUND P, ERIKSSON T. Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital. Pharm World Sci 2008; 30: 840-845.
MEKONNEN AB, ABEBE TB, MCLACHLAN AJ, BRIEN JA. Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2016; 16: 112.
CONLEY J, O'BRIEN CW, LEFF BA, BOLEN S, ZULMAN D. Alternative strategies to inpatient hospitalization for acute medical conditions: a systematic review. JAMA Intern Med 2016; 176: 1693- 1702.
POWERS BW, MILSTEIN A, JAIN SH. Delivery models for high-risk older patients: back to the future? JAMA 2016; 315: 23-24.
JOO JY, LIU MF. Case management effectiveness in reducing hospital use: a systematic review. Int Nurs Rev 2016; 64: 296-308.
MONZA K, HARRIS D, SHAW C. The role of the nurse navigator in the management of the heart failure patient. Crit Care Nurs Clin North Am 2015; 27: 537-549.
PEIKES D, CHEN A, SCHORE J, BROWN R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA 2009; 301: 603-618.
VUOKKO R, MAKELA-BENGS P, HYPPONEN H, LINDQVIST M, DOUPI P. Impacts of structuring the electronic health record: Results of a systematic literature review from the perspective of secondary use of patient data. Int J Med Inform 2017; 97: 293-303.
CONTHE GP, GARCIA AJ, PUJOL FR, ALFAGEME M, I, ARTOLA MS, BARBA MR et al. [Consensus for hospital discharge reports in medical specialities]. Med Clin (Barc) 2010; 134: 505-510.
WILDEVUUR SE, SIMONSE LW. Information and communication technology-enabled person-centered care for the "big five" chronic conditions: scoping review. J Med Internet Res 2015; 17: e77. doi: 10.2196/jmir.3687.
DE JONGH T, GUROL-URGANCI I, VODOPIVEC-JAMSEK V, CAR J, ATUN R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev 2012; 12: CD007459.
NUNO-SOLINIS R, RODRIGUEZ-PEREIRA C, PINERA-ELORRIAGA K, ZABALLA-GONZALEZ I, BIKANDI-IRAZABAL J. [Panorama of self-management initiatives in Spain]. Gac Sanit 2013; 27: 332-337.
FOSTER G, TAYLOR SJ, ELDRIDGE SE, RAMSAY J, GRIFFITHS CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev 2007; CD005108.
GRIFFITHS C, FOSTER G, RAMSAY J, ELDRIDGE S, TAYLOR S. How effective are expert patient (lay led) education programmes for chronic disease? BMJ 2007; 334: 1254-1256.
HIGGINS JPT, ALTMAN DG, STERNE JAC. Assessing risk of bias included studies. En: Higgins JPT, Green S, editores. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, 2011. www.cochrane-handbook.org.
DIAZ-LOBATO S, GONZALEZ LF, GOMEZ MENDIETA MA, MAYORALAS AS, MARTIN A, I, VILLASANTE FERNANDEZ-MONTES C. [Evaluation of a home hospitalization program in patients with exacerbations of chronic obstructive pulmonary disease]. Arch Bronconeumol 2005; 41: 5-10.
FARRERO E, ESCARRABILL J, PRATS E, MADERAL M, MANRESA F. Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy. Chest 2001; 119: 364-369.
MENDOZA H, MARTIN MJ, GARCIA A, AROS F, AIZPURU F, REGALADO DE LOS COBOS J et al. 'Hospital at home' care model as an effective alternative in the management of decompensated chronic heart failure. Eur J Heart Fail 2009; 11: 1208-1213.
HERNANDEZ C, CASAS A, ESCARRABILL J, ALONSO J, PUIG-JUNOY J, FARRERO E et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J 2003; 21: 58-67.
FERRER-ROCA O, GARCIA-NOGALES A, PELAEZ C. The impact of telemedicine on quality of life in rural areas: the Extremadura model of specialized care delivery. Telemed J E Health 2010; 16: 233-243.
JANSA M, VIDAL M, VIAPLANA J, LEVY I, CONGET I, GOMIS R et al. Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control. Diabetes Res Clin Pract 2006; 74: 26-32.
SEGURANYES G, COSTA D, FUENTELSAZ-GALLEGO C, BENEIT JV, CARABANTES D, GOMEZ-MORENO C et al. Efficacy of a videoconferencing intervention compared with standard postnatal care at primary care health centres in Catalonia. Midwifery 2014; 30: 764-771.
BROTONS C, FALCES C, ALEGRE J, BALLARIN E, CASANOVAS J, CATA T et al. Randomized clinical trial of the effectiveness of a home-based intervention in patients with heart failure: the IC-DOM study. Rev Esp Cardiol 2009; 62: 400-408.
CANO AA, MARTIN ARRIBAS MC, MARTINEZ PM, GARCIA TC, HERNANDEZ PM, ROLDAN FA. [Efficacy of nursing planning after hospital discharge of patients over 65 to reduce their readmission]. Aten Primaria 2008; 40: 291-295.
CASAS A, TROOSTERS T, GARCIA-AYMERICH J, ROCA J, HERNANDEZ C, ALONSO A et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J 2006; 28: 123-130.
MORALES-ASENCIO JM, GONZALO-JIMENEZ E, MARTIN-SANTOS FJ, MORILLA-HERRERA JC, CELDRAAN-MANAS M, CARRASCO AM et al. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study. BMC Health Serv Res 2008; 8: 193.
GARCIA-AYMERICH J, HERNANDEZ C, ALONSO A, CASAS A, RODRIGUEZ-ROISIN R, ANTO JM et al. Effects of an integrated care intervention on risk factors of COPD readmission. Respir Med 2007; 101: 1462-1469.
HERNANDEZ C, ALONSO A, GARCIA-AYMERICH J, GRIMSMO A, VONTETSIANOS T, GARCIA CF et al. Integrated care services: lessons learned from the deployment of the NEXES project. Int J Integr Care 2015; 15: e006.
HERNANDEZ C, ALONSO A, GARCIA-AYMERICH J, SERRA I, MARTI D, RODRIGUEZ-ROISIN R et al. Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial. NPJ Prim Care Respir Med 2015; 25: 15022. doi: 10.1038/npjpcrm.2015.22.
ATIENZA F, ANGUITA M, MARTINEZ-ALZAMORA N, OSCA J, OJEDA S, ALMENAR L et al. Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail 2004; 6: 643-652.
MORCILLO C, VALDERAS JM, AGUADO O, DELAS J, SORT D, PUJADAS R et al. [Evaluation of a home-based intervention in heart failure patients. Results of a randomized study]. Rev Esp Cardiol 2005; 58: 618-625.
MORELL F, OJANGUREN I, CORDOVILLA R, URRUTIA I, AGUERO R, GUERRA J et al. Two short interventions to reduce health care requirements in asthma patients. A multicentre controlled study (ASTHMACAP II). Med Clin (Barc) 2014; 142: 348-354.
PERULA LA, VARAS-FABRA F, RODRIGUEZ V, RUIZ-MORAL R, FERNANDEZ JA, GONZALEZ J et al. Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93: 1677-1684.
AGUADO O, MORCILLO C, DELAS J, RENNIE M, BECHICH S, SCHEMBARI A et al. Long-term implications of a single home-based educational intervention in patients with heart failure. Heart Lung 2010; 39: S14-S22.
JODAR-SANCHEZ F, ORTEGA F, PARRA C, GOMEZ-SUAREZ C, JORDAN A, PEREZ P et al. Implementation of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy. J Telemed Telecare 2013; 19: 11-17.
MARTIN-LESENDE I, ORRUNO E, BILBAO A, VERGARA I, CAIRO MC, BAYON JC et al. Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial). BMC Health Serv Res 2013; 13: 118. doi: 10.1186/1472-6963-13-118.
SEGRELLES CG, GOMEZ-SUAREZ C, SORIANO JB, ZAMORA E, GONZALEZ-GAMARRA A, GONZALEZ-BEJAR M et al. A home telehealth program for patients with severe COPD: the PROMETE study. Respir Med 2014; 108: 453-462.
BARBERAN-GARCIA A, VOGIATZIS I, SOLBERG HS, VILARO J, RODRIGUEZ DA, GARASEN HM et al. Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries. Respir Med 2014; 108: 628-637.
MIRA JJ, NAVARRO I, BOTELLA F, BORRAS F, NUNO-SOLINIS R, OROZCO D et al. A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial. J Med Internet Res 2014; 16: e99. doi: 10.2196/jmir.3269.
GONZALEZ-CARRASCOSA-VEGA T, SIERRA-SANCHEZ JF, MARTINEZ-BAUTISTA MJ, GARCIA-MARTIN F, SUAREZ-CARRASCOSA F, BAENA-CANADA JM. Medication reconciliation in oncological patients: a randomized clinical trial. J Manag Care Spec Pharm 2016; 22: 734-740.
FALCES C, ANDREA R, HERAS M, VEHI C, SORRIBES M, SANCHIS L et al. [Integration between cardiology and primary care: impact on clinical practice]. Rev Esp Cardiol 2011; 64: 564-571.
GONZALEZ-MESTRE A. [Autonomy of the patient with chronic diseases: from passive patient to active patient]. Enferm Clin 2014; 24: 67-73.
GONZALEZ-MESTRE A. Executive summary of Expert Patient Programme of Catalonia January of 2015.
http://salutweb.gencat.cat/web/.content/home/ambits_tematics/linies_dactuacio/ model_assistencial/atencio_al_malalt_cronic/documents/expert_patient_progra mme_catalonia_2015.pdf . Consultado el 30 de marzo de 2017.
TORO-POLANCO N, ZABALEGUI IB, IRAZUSTA IP, NUNO-SOLINIS R, DEL RIO CM. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation. Int J Integr Care 2015; 15: e026.
WANG T, TAN JY, XIAO LD, DENG R. Effectiveness of disease-specific self-management education on health outcomes in patients with chronic obstructive pulmonary disease: An updated systematic review and meta-analysis. Patient Educ Couns 2017; 100: 1432-1446.
OYANGUREN J, LATORRE GARCIA PM, TORCAL LJ, LEKUONA G, I, RUBIO MS, MAULL LE et al. Effectiveness and factors determining the success of management programs for patients with heart failure: a systematic review and meta-analysis. Rev Esp Cardiol (Engl Ed) 2016; 69: 900-914.
QADDOURA A, YAZDAN-ASHOORI P, KABALI C, THABANE L, HAYNES RB, CONNOLLY SJ et al. Efficacy of hospital at home in patients with heart failure: a systematic review and meta-analysis. PLoS One 2015; 10: e0129282. doi: 10.1371/journal.pone.0129282.
JEPPESEN E, BRURBERG KG, VIST GE, WEDZICHA JA, WRIGHT JJ, GREENSTONE M et al. Hospital at home for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; CD003573.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
