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Anales del Sistema Sanitario de Navarra
versión impresa ISSN 1137-6627
Resumen
CORRAL GUDINO, L.; BORAO CENGOTITA-BENGOA, M.; JORGE SANCHEZ, R.J. y GARCIA APARICIO, J.. The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain. Anales Sis San Navarra [online]. 2017, vol.40, n.3, pp.443-459. ISSN 1137-6627. https://dx.doi.org/10.23938/assn.0119.
Background
Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. This study estimates the effectiveness in of different tools for integrated care in Spain.
Methods
We performed a systematic review of articles using MEDLINE (last search July31st, 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment.
Results
Twenty studies met the criteria for the systematic review. Interventions included were hospital-at-home (four studies, 455 patients), outpatient clinic by videoconference (three studies, 2438 patients), nurse navigator (four studies, 1051 patients), self-care improvement (four studies, 1291 patients), at-home health monitoring (three, 162), health apps (two, 225) and medical reconciliation (one, 172). Hospital-at-home, nurse navigator or self-care improvement reduced readmission rate in older patients, heart failure (HF) or chronic obstructive pulmonary disease (COPD). Self-care improvement and nurse navigator reduced mortality rate in HF. Hospital-at-home reduced hospital stay in COPD. Self-care improvement reduced outpatient visits in asthma patients. Outpatient video by videoconference reduced time to diagnosis and treatment in rural areas. The quality of the evidence ranged from low to very low for all the outcomes because it was based in double or triple downgraded randomized trials.
Conclusion
The implementation of tools for integrated care in Spain improved some outcomes of relevance in patients with chronic conditions, although evidence is low. Self-care improvement stood out due to the improvements made.
Palabras clave : Continuity of patient care; Primary Health Care; Home Care Services; Hospital-Based; Self-care; Outpatients.