Influencia de la consulta monográfica de insuficiencia cardiaca crónica y comorbilidad asociada dirigida por internistas sobre la calidad asistencial y hospitalizaciones relacionadas

Abstract

TARGET: To determine the impact of a monographic consultation, in which internists and specialized nursing play a main role, for patients with Chronic Heart Failure (CHF) and associated comorbidity on the quality of care and hospital readmission of these patients, as well as its influence on hospital global admission due to CHF. MATERIAL AND METHODS: Prospective and retrospective cohort study with a scope of 169 patients with CHF, belonging to two hospitals with a different care level (district and provincial level), included in two similar monographic consultations. The percentage of patients receiving 1st-line drugs as well as their compliance are evaluated and compared to the admission rate due to CHF both during the previous year to the study and the year following the study. In order to find out the impact of these consultations according to data provided by hospitals, the development of the total number of admissions and average stay length due to CHF (GRDs 127, 544) from 2001 to 2009 are analyzed. The beginning of consultations falls on the middle point of this period. RESULTS: A high percentage of patients subject to monitoring received 1st-line drugs (97.8% IECAS/ARA-II and 88% BB) with a very high compliance (90%). The readmission rate has been reduced down to 69% as compared to previous year. According to the data provided by both hospitals, the global stay length of Internal Medicine patients due to CHF has been reduced in 3.5 days, the number of patients handled in the Internal Medicine Area due to CHF has increased and the total admission rate due to CHF during the year period 2001-2009 has been reduced. CONCLUSION: On what CHF and comorbidity patients are concerned, following a health program in which internists and specialized nursing play a main role and which is based on a continuous and comprehensive tracking, patient information, staff training and availability, is a good way not only to reduce the readmission of monitored patients, but also to also to improven CHF hospital stay global rates of these patients.