El paciente y su travesía entre la atención primaria y la hospitalaria. Revisión sistemática de ensayos clínicos para la implementación de herramientas para la integración en España
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https://doi.org/10.23938/ASSN.0119Gako-hitzak:
"Continuity of patient care". "Primary Health Care". "Home Care Services, Hospital-Based". "Self-care". "Outpatients"Laburpena
Fundamento. Los servicios de salud evolucionan hacia la integración, reduciendo la fragmentación de la atención, mejorando la eficiencia y los resultados en salud. Este trabajo valora la efectividad de distintas herramientas para la integración en España.
Método. Revisión en MEDLINE(última búsqueda:31-julio-2017) deensayos clínicos realizados en España. El riesgo de sesgo se valoróutilizando la propuesta de la colaboración Cochrane.
Resultado. Se incluyeron veintiún estudios: hospitalización a domicilio (cuatro estudios, 455 pacientes), consultas externas mediante videoconferencia (tres, 2438), enfermeras de enlace (cuatro, 1051), mejora del auto-cuidado (cuatro, 1219), monitorización de parámetros biomédicos en domicilio (tres, 162), uso de aplicaciones informáticas (dos, 225) y conciliación de la medicación (uno, 172). La hospitalización a domicilio, las enfermeras de enlace y la mejora del auto-cuidado redujeron los reingresos en pacientes ancianos, con insuficiencia cardiaca (IC) o enfermedad pulmonar obstructiva crónica (EPOC). La mejora del auto-cuidado y las enfermeras de enlace disminuyeron la mortalidad en IC. La hospitalización a domicilio disminuyó los días de hospitalización en EPOC. La mejora del autocuidado redujo el número de visitas a consulta en asma. La consulta externa mediante videoconferencia disminuyó el tiempo hasta el diagnóstico y el tratamiento en áreas rurales. La calidad de la evidencia fue baja o muy baja ya que los estudios tenían dos o más riesgos de sesgo.
Conclusiones. La aplicación de herramientas para la integración mejoró algunos resultados en salud en pacientes con enfermedades crónicas, aunque la evidencia es escasa. De todas las herramientas cabe destacar los resultados de la mejora del auto-cuidado.
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