Análisis de una intervención para la mejora de resultados en salud en EPOC agudizada en atención primaria

Abstract

ObjectiveTo examine the impact of an intervention by Primary Care (PC) professionals of a Health District on the clinical outcomes for treating COPD exacerbations using a process and outcome indicators analysis (clinical audit). DesignObservational, retrospective and prospective analysis cross-sectional audit of clinical practice SettingMalaga-Guadalhorce Sanitary District (DSMG). ParticipantsPatients with COPD exacerbations treated by the extra-hospital emergency services (n=523; 21% losses). InterventionsProfessional training in the usual clinical practice and inclusion of process indicators of COPD targets in relation to incentives. Principal measurementsComparison of external audit results (process and outcomes variables) from medical records and Health Outcomes (exacerbations, admissions). Variable response: Difference in exacerbations and admissions in 2 periods analysed. Bivariate and multivariate analysis. ResultsMean age was 75 (±9.3), 63.7% males with a BMI of 29.4 (±7.1), and 21% active smokers. Mean FEV1, 48.2% (±18.7). Mean exacerbations in the first period, 2.86 (±2.29) and in the second 1.36 (±1.56) (P<.001). Mean hospital admissions in the first and second period, 0.56 (±0.94) and 0.31 (±0.66) (P<.001), respectively. The decrease in the number of exacerbations was directly associated with having ≥2 exacerbations in the first period, reviewed in Primary Care, and inversely with heart failure and with having ≥2 exacerbations in the second period (R2=0.28; P<.001) ConclusionsThe number of exacerbations and admissions decreased significantly in both periods assessed. However, the evaluated process indicators did not improve. Prospective intervention studies are necessary to establish the possible causal relationship.