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Inicio Medicina Clínica (English Edition) A multidisciplinary approach for patients with multiple chronic conditions: IMPA...
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Vol. 153. Issue 3.
Pages 93-99 (August 2019)
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Vol. 153. Issue 3.
Pages 93-99 (August 2019)
Original article
DOI: 10.1016/j.medcle.2019.01.022
A multidisciplinary approach for patients with multiple chronic conditions: IMPACTO study
Plan de asistencia continuada multidisciplinar a pacientes pluripatológicos: estudio IMPACTO
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Maria Dolores Nieto-Martína,
Corresponding author
lonietoma@gmail.com

Corresponding author.
, Laura De la Higuera-Vilab, Maximo Bernabeu-Wittela, Maria Angeles González-Benitezc, Eva Rocío Alfaro-Larae, Miguel Angel Barón-Ramosf, Esperanza Montero-Apariciog, Reyes Aparicio-Santosh, Manuel Ollero Baturonea
a Internal Medicine Department, University Hospital Virgen del Rocío, Avd. Manuel Siurot, s/n, 41013 Seville, Spain
b Internal Medicine Department, Bidasoa Hospital, Barrio Mendelu s/n, 20280 Hondarribia, Guipúzcoa, Spain
c Internal Medicine Department, Serranía de Ronda Hospital, Carretera del Burgo, Km 1, 29400 Ronda, Málaga, Spain
e Andalusian Agency for Health Technology Assessment, Avda de la Innovación, Edificio ARENA 1, 41020 Seville, Spain
f Internal Medicine Department, Hospital Serranía de Ronda, Carretera del Burgo, Km 1, 29400 Ronda, Málaga, Spain
g Internal Medicine Department, Mendaro Hospital, C/ Mendarozabal s/n, 20850 Guipúzcoa, Spain
h Internal Medicine Department, Hospital San Juan De Dios del Aljarafe, Avd. San Juan de Dios s/n, 41930 Seville, Spain
The list of researchers involved in the IMPACTO study and their affiliations
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Tables (4)
Table 1. Characteristics of the 11 multidisciplinary interventions defined for the IMPACTO study.
Table 2. Socio-demographic and clinical baseline characteristics of the polypathological included in the IMPACTO study.
Table 3. Hospital admissions in the year previous and the year after inclusion in the IMPACTO study.
Table 4. Univariate and multivariate analysis results associated to 12 months mortality.
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Abstract
Background and objective

The objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP).

Methods

A multicenter quasi-experimental pre-post study with a 12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality.

Results

420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15–2.46, p=0.007 and HR: 2.86; 95% CI: 1.92–4.27, p<0.001, respectively.

Conclusions

This multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival.

Keywords:
Polypathological patients
Multidisciplinary interventions
Hospital admissions
Mortality
Resumen
Introducción y objetivo

El objetivo del estudio fue evaluar los resultados en salud tras la implantación de una intervención multidisciplinar a pacientes pluripatológicos (PP).

Metodología

Se realizó un estudio multicéntrico antes-después cuasi-experimental, con seguimiento a 12 meses. Se incluyeron pacientes que cumplían los criterios de PP entre marzo de 2012 y octubre de 2013, tanto en el ámbito hospitalario como en atención primaria. El enfoque multidisciplinar fue definido por 11 intervenciones realizadas por médicos de familia, médicos internistas, enfermeras y farmacéuticos hospitalarios. El resultado fundamental fue la reducción en el número de ingresos hospitalarios y días de hospitalización al año de seguimiento. Los resultados secundarios incluyeron la mortalidad y los efectos de las intervenciones sobre la misma.

Resultados

Se incluyeron 420 pacientes. La edad media de los pacientes fue de 77,3 (DE: 8,90) y la media de categorías definitorias de PP fue de 2,99 (DE: 1,00). El número de ingresos hospitalarios y los días de hospitalización disminuyeron significativamente después de la intervención: 1,52 (DE: 1,35) versus 0,82 (DE: 1,29), p<0,001 y 13,77 (DE: 15,20) versus 7,21 (DE: 12,90), p<0,001, respectivamente. La mortalidad a los 12 meses fue del 37,7%. Los PP que no recibieron la visita médica estructurada del médico internista tras la inclusión y los talleres educativos de las enfermeras tuvieron un mayor riesgo de exitus en los 12 meses de seguimiento, HR: 1,68; IC del 95%: 1,15-2,46, p=0,007 y HR: 2,86; IC del 95%: 1,92-4,27, p<0,001, respectivamente.

Conclusiones

Esta intervención multidisciplinaria reduce el riesgo de ingreso y los días de ingreso hospitalario en PP. Los programas de talleres educativos para PP y sus cuidadores, y las visitas médicas estructuradas por parte de medicina interna se asociaron con una mayor supervivencia.

Palabras clave:
Pacientes pluripatológicos
Intervenciones multidisciplinares
Ingresos hospitalarios
Mortalidad

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