Descripción de actividad asistencial en las Unidades de Hospitalización a Domicilio de Osakidetza – Servicio Vasco de Salud

Introduction: Hospitalization at Home (HaH) Units present differences in their content and conditions of care. The Basque HaH Society initiated a research project in 2018 to define useful indicators to compare the activity of teams with different care content. One phase of the project involved recording characteristics of episodes attended and care provided. It is of interest to disclose the results of the registry. Method: Between May 1 and May 31, 2021, 9 Units recorded certain characteristics of the patients seen, as well as type, frequency and duration of visits performed. Descriptive data on these variables are shown for the overall series and for each unit. Results: 1171 episodes and 8363 visits in 14458 stays were analysed (82% of actual stays). On average, 65% of patients received a visit during working days and 42% during non-working days. The percentage of cases in each clinical type varied according to Units: acute pathology between 12 and 48%; palliative care between 20% and 40%; surgical pathology between 2.3 and 30%. There were also differences in age, sex and geographical dispersion. Mortality and hospital referral varied between Units and also between pathologies. The duration of direct care varied between Units from 24.4 to 35.9 min, and the duration of travel for each visit from 11.9 to 25 min, probably related to the type of pathology and geographical dispersion, respectively. Conclusions: There are indeed differences in the content and working conditions of the different HaH Units. It is necessary to analyse how much they influence the activity and outcome measures in order to have adjusted indicators.Introducción: Las Unidades de Hospitalización a Domicilio (HaD) presentan diferencias en su contenido y condiciones de asistencia. La Sociedad Vasca de HaD inició en 2018 un proyecto de investigación para definir indicadores que permitan comparar la actividad de equipos que tienen contenidos asistenciales diferentes. Una fase del proyecto implicó el registro de características de los episodios atendidos y la atención prestada. Dar a conocer el resultado del registro es de interés. Método: Entre 1 y 31 de mayo de 2021, 9 Unidades registraron ciertas características de los pacientes atendidos, así como tipo, frecuencia y duración de las visitas realizadas. Se muestran los descriptivos de estas variables en la serie global y en cada Unidad. Resultados: Se analizaron 1171 episodios y 8363 visitas en 14458 estancias. (82% de estancias reales). De media, en laborable se visitó al 65% de los pacientes y en no laborable al 42%. El porcentaje de casos en cada tipo clínico varió según Unidades: patología aguda entre 12 y 48%; cuidados paliativos entre 20% y 40%; patología quirúrgica entre 2.3 y 30 %. Se apreciaron también diferencias en edad, sexo y dispersión geográfica. Mortalidad y reenvío al hospital variaron entre Unidades y también entre patologías. La duración de la atención directa varió entre Unidades entre 24,4 y 35.9 min, y la del desplazamiento para cada visita entre 11.9 y 25 min, en probable relación con el tipo de patología y la dispersión geográfica respectivamente. Conclusiones: Se constata que existen diferencias en el contenido y condiciones de trabajo de las distintas Unidades de H a D. Es necesario analizar cómo influyen en las medidas de actividad y de resultado para disponer de indicadores ajustados

Effectiveness of a Structured Group Intervention Based on Pain Neuroscience Education for Patients with Fibromyalgia in Primary Care: a Multicentre Randomized Open-Label Controlled Trial

Background There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM). Methods A multicentre randomized, open-label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses. Results At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of >= 20% in 69.1% of patients (20.9% in the control group) and of >= 50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group). Conclusions In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes. Significance A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.Partial reduction of routine work tasks of the principal investigator, MJ Barrenengoa-Cuadra, was supported by a grant from OSI Bilbao Basurto Osakidetza, Basque country, Spain (the grant was paid to the Health Service to substitute MJ Barrenengoa-Cuadra while research work)