Monitoring Of Chronic Patients Research Articles

Guideline changes in pediatric gastroenterology and digestive endoscopy in the context of the SARS-CoV-2 pandemic

The current pandemic raised unique challenges for the medical system and consequently for the pediatric gastro­en­te­rology as well. Endoscopic procedures entail a high degree of infectiousness due to the generation of aerosols and are conducted in accordance with strict protocols that entail circuit separation measures for patients with minimal risks, suitable protection gear and precise indications. The pediatric gastrointestinal pathology can influence the need for an urgent endoscopy (high severity of intestinal inflam­matory disease, foreign body ingestion, congenital mal­for­ma­tions etc.) and requires the prioritizing of pro­ce­dures, a careful analysis of the benefits and risks, along with the patient’s symptoms, and allotting the necessary re­sources for the screening of SARS-CoV-2 infection. The monitoring of chronic patients is carried out on an in­di­vi­dua­lized basis, using telemedicine, which was also recently introduced in Romania. Observing the indications of the treating physician/general practitioner and giving the treatment correctly are essential for chronic patients in order to reduce the number of hospital admissions.

Personal Health Records, Agents Technology and Ontologies for Homecare Monitoring of Chronic Patients

This article proposes the use of agent technologies, ontologies and rules-based monitoring, which represents medical knowledge as tools to support home monitoring of chronic patients, evaluating their data and generating alerts. It also presents a case study with patients on oral anticoagulant treatment in Spain, showing how to the monitoring is performed into repositories of Personal Health Records for patients through the use of software agents and ontologies, allowing the extraction and integration of data.

Variability in the detection and monitoring of chronic patients in primary care according to what is registered in the electronic health record

The electronic health record (EHR) allows a detailed study of the primary care consultations and assessment of variability among physicians regarding the implementation of practices for prevention, detection and monitoring of chronic diseases. To describe the variability in the detection and surveillance of chronic conditions in primary care. Review of the medical records maintained by 1685 primary care physicians in the Basque Health Service. Estimation of age and sex standardized rates of compliance with evidence-based recommendations and the systematic component of variation (SCV). Compliance with screening recommendations varied from 14.2% for chronic obstructive pulmonary disease (COPD) to 37.2% for hypercholesterolaemia of the at-risk populations. Variability between Primary Care Units (PCUs) was low (SCV(5) (-95) < 0.10) for high blood pressure, hypercholesterolaemia and diabetes and high (SCV(5) (-95) ≥ 0.20) for COPD. Based on the EHR registries, recommendations were followed to in at least 50% of relevant patients according to only 10 of the 44 good care practice (GCP) criteria. For 16 of the GCP criteria, the EHR data indicated compliance to the recommendations in <25% of patients diagnosed. EHR data indicate that some of the preventative care practices recommended to detect chronic problems in primary care are unevenly implemented across PCUs. Notably, there is less variation in the case of conditions for which evidence-based clinical practice guidelines have been published. The level of monitoring is inadequate for all the conditions studied; particularly in those in which it is less evident that primary care is the right level of the health service to provide this care.

Integration Between Cardiology and Primary Care: Impact on Clinical Practice

Introduction and objectives To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools. Methods Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources. Results We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, β-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased. Conclusions Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians’ satisfaction levels improved. There was no increase in use of resources.

Integración entre cardiología y atención primaria: impacto sobre la práctica clínica

Introduction and objectives To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools. Methods Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources. Results We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, β-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased. Conclusions Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians’ satisfaction levels improved. There was no increase in use of resources. Full English text available from: www.revespcardiol.org