[Individualised multidisciplinary care programme in frail patients (PAMI)]

Artetxe J, Aranegi P, Zubeldia X, Álvarez MT, Zamarreño I, Huerta I, Agirre C, Goicoechea X, Basabe I, Clave E, Leizaola K, Urreta I, Emparanza JI, Echegaray M
Record ID 32018000585
Original Title: Programa de asistencia multidisciplinar individualizado en paciente frágil (PAMI)
Authors' objectives: Improve the perceived quality of care and reduce the number of admissions and visits to emergency services
Authors' results and conclusions: The perceived quality of care is measured by means of focus groups. The two most highly valued elements were the availability of the referral Doctor-Nurse and improved accessibility in the case of flareups. Therapeutic compliance was 97.9% (IC 95% 95.4 to 98,83). The number of admission days was reduced by 60.7% (CI 95% 58.7 to 62.7) and the number of visits to the Emergency Services was reduced by 77% (CI 95% 73.2 to 80.3). CONCLUSIONS Organisational measures, using the resources currently available, can reduce the number of visits to the emergency services, days of admission and improve the quality of care perceived by patients readmitted with heart failure and chronic obstructive pulmonary disease.
Authors' methods: Design: Prospective cohort study of 242 patients at risk of readmission with chronic obstructive pulmonary disease or heart failure, recruited between July 1, 2009 and July 1, 2010. Cohort monitoring was completed on December 30, 2010. "Before-after" design. Environment: University Hospital in Donostia (Gipuzkoa-Spain). Description of the intervention: Identification of the non-dependent readmission patient Personalised information. Assignment of Referring Physician and liaison nurse with structured monitoring by telephone and consultations. Contact with the family doctor. Referral telephone for flare-ups.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Other
Country: Spain
MeSH Terms
  • Frail Elderly
  • Heart Failure
  • Pulmonary Disease, Chronic Obstructive
  • Patient Readmission
  • Continuity of Patient Care
  • Frail Elderly
  • Heart Failure
  • Chronic Obstructive Pulmonary Disease
  • Continuity of Patient Care
  • Patient Readmission
  • Readmisión del Paciente
  • Continuidad de la Atención al Paciente
  • Enfermedad pulmonar obstructiva crónica
  • Insuficiencia Cardíaca
  • Anciano Frágil
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.