de-la-Rica-Escuín Marisa, García-Barrecheguren Ana, Monche-Palacín Ana María
Instituto de Investigación Sanitaria de Aragón, Facultad de Ciencias de la Salud, Zaragoza, España.
Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Enferm Clin (Engl Ed). 2019 Jan-Feb;29(1):18-26. doi: 10.1016/j.enfcli.2018.07.004. Epub 2018 Aug 14.
To describe the advanced chronic patients admitted to an internal medicine department and to identify whether they meet the criteria for the need for palliative care at the time of hospital discharge according to the NECPAL-CCOMS.ICO instrument.
Observational, descriptive and cross-sectional study performed on patients admitted to the internal medicine department of the Hospital Clínico Universitario Lozano Blesa (Saragossa), with a diagnosis of advanced progressive chronic diseases, from May 1, 2017 to September 1, 2017 Variables: sex, age, advanced chronic disease, reason for admission, primary caregiver, origin (residence, address, etc.), number of readmissions in the previous year, existence of advance directives, disability of the patient, existence of order not to resuscitate, Charlson Index and all the variables contained in the NECPAL Instrument CCOMS-ICO ® VERSION 3.0 2016. The data collection was done when the patient was scheduled to be discharged, having resolved the acute circumstance that led to the admission.
the sample size was 142 patients who met the inclusion criteria: diagnosis of disease advanced evolutionary chronic ages, Charlson Index ≥3 at the time the patient was scheduled to be discharged and signed their informed consent. The average age was 85.80 years and 50.7% were men. The average age of the women was higher than that of the men. The most prevalent advanced chronic disease was chronic heart disease. None of the patients had advance care directives in place.. Nutritional, functional, cognitive and severe dependence was determined in more than 50%. In more than 90% there was the presence of geriatric syndromes and persistent symptoms. The presence of emotional distress was also evident, as was the use of resources.
A palliative approach in the care of chronicity would have a very positive impact on the quality of life of the patient and family, would positively influence health systems and would result in cost savings. Implementing the NECPAL CCOMS-ICO instrument in the health services that serve high proportions of chronically ill patients, accompanied by training measures for health personnel and adaptation of resources, can introduce a qualitative and quantitative change that is very relevant in our the health system.
描述内科收治的晚期慢性病患者，并根据NECPAL - CCOMS.ICO工具确定他们在出院时是否符合姑息治疗需求标准。
对洛萨诺·布莱萨大学临床医院（萨拉戈萨）内科收治的诊断为晚期进行性慢性病的患者进行观察性、描述性和横断面研究，研究时间为2017年5月1日至2017年9月1日。变量：性别、年龄、晚期慢性病、入院原因、主要照顾者、来源（居住地、地址等）、上一年再次入院次数、是否有预先指示、患者残疾情况、是否有不进行心肺复苏的医嘱、查尔森指数以及NECPAL工具CCOMS - ICO® 2016版3.0中包含的所有变量。数据收集在患者预定出院时进行，此时导致入院的急性情况已得到解决。
样本量为142名符合纳入标准的患者：疾病诊断为晚期慢性进展性、患者预定出院时查尔森指数≥3且签署知情同意书。平均年龄为85.80岁，50.7%为男性。女性的平均年龄高于男性。最常见的晚期慢性病是慢性心脏病。没有患者制定预先护理指示。超过50%的患者存在营养、功能、认知和严重依赖问题。超过90%的患者存在老年综合征和持续症状。情绪困扰的存在也很明显，资源使用情况同样如此。
对慢性病护理采用姑息治疗方法将对患者及其家庭的生活质量产生非常积极的影响，将对卫生系统产生积极影响并节省成本。在为大量慢性病患者提供服务的卫生机构中实施NECPAL CCOMS - ICO工具，同时采取针对卫生人员的培训措施并调整资源，可以带来在我们的卫生系统中非常重要且相关的定性和定量变化。
