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. 2003 May 15;31(8):473-7.
doi: 10.1016/s0212-6567(03)70718-5.

[An approach to home care. How does the Catalonian public health system handle home care?]

[Article in Spanish]
Grupo ATDOM de la Societat Catalana de Medicina Familiar i Comunitària

[An approach to home care. How does the Catalonian public health system handle home care?]

[Article in Spanish]
Grupo ATDOM de la Societat Catalana de Medicina Familiar i Comunitària. Aten Primaria. .

Abstract
in English, Spanish

Objective: To describe the organizational model, resources and implementation of the home care program run by the Catalonian public health service, and to note difficulties reported by primary care professionals.

Design: Cross-sectional, descriptive study.Setting. Autonomous Community of Catalonia.

Participants: 214 primary care centers (PCCs) operating under reformed administrative procedures were surveyed, and responses were obtained from 112 (52.3%).

Main measures: Semistructured, self-administered questionnaire sent by mail, with variables that identified the center, resources, organization and use of protocols for home care. Questionnaires were collected during July to November, 2000.

Results: Home care programs were being used at 90.2% (95% CI, 84.7%-95.7%) of the centers, and had been in effect for a mean of 5.6 years. Nursing services predominated in 64% of the case, with nurses spending a mean of 5.09 h/week on the program, twice as much time as physicians and social workers. The mean rate of computerization of the data was 31.3%, and was highest (P<.05) in Gerona (51%) and in PCCs run privately (70%). Of all participating PCCs, 70% had social workers on the staff, 13% had a home care nurse and 50% operated in coordination with social services. Of all PCCs, 79.5% (95% CI, 72.1%-86.9%) used specific protocols for pressure sores (69.1%), terminal illnesses (43.6%), bedridden patients (41.8%) and pain management (40.9%). Evaluations were done with the Barthel scale (73.2%), the Mini-Mental State Examination (73.2%) and the Norton scale (53.6%). Continuing education (66%) and activities for care providers (>75%) were frequent in home care programs. The main difficulties identified were the burden of care (65.2%), time constraints (51.8%), inadequate social support (43.8%) and lack of coordination with other levels of care (33%).

Conclusions: Noteworthy findings were the dedication of nursing staff to the home care programs, the low level of computerization of the data, the limitations in social service resources, the uniformity of assessment protocols and scales, and the agreement regarding current difficulties.

Objetivo: Conocer el modelo de organización, recursos e implementación del programa de atención domiciliaria (ATDOM) en la sanidad pública catalana, y las dificultades expresadas por los profesionales de atención primaria.

Diseño: Estudio descriptivo transversal.

Emplazamiento: Comunidad Autónoma de Cataluña.

Participantes: Un total de 214 centros de atención primaria (CAP) reformados, de los que respondieron al cuestionario 112 (52,3%).

Mediciones principales: Cuestionario semiestructurado y autoadministrado enviado por correo, con variables para la identificación del centro, sus recursos, organización y protocolización de la ATDOM. La recogida de respuestas se efectuó entre julio y noviembre de 2000.

Resultados: La utilización del programa ATDOM fue del 90,2% (IC del 95%, 84,7–95,7%), con 5,6 años de aplicación media. La enfermería lidera el programa en el 64% de los casos, dedicando 5,09 h/semana, el doble que los médicos y los trabajadores sociales. La informatización de datos es un 31,3%, más elevada (p < 0,05) en Gerona (51%) y en los CAP de gestión privada (70%). El 70% de los CAP posee un trabajador social, el 13% dispone de una enfermera de soporte y el 50% está coordinado con centros sociosanitarios. El 79,5% (IC del 95%, 72,1–86,9%) de los CAP utiliza protocolos específicos: úlceras (69,1%), terminales (43,6%), encamados (41,8%) y dolor (40,9%). La valoración se realiza con las escalas de Barthel (73,2%), Mini-Examen-Cognoscitivo (73,2%) y Norton (53,6%). Son frecuentes la formación continuada en ATDOM (66%) y las actividades para cuidadores (> 75%). Las principales dificultades son la presión asistencial (65,2%), el tiempo (51,8%), los recursos sociales insuficientes (43,8%) y la falta de coordinación con otros niveles asistenciales (33%).

Conclusiones: Se destacan el compromiso de la enfermería en ATDOM, la escasa informatización y la limitación de los recursos sociosanitarios, la uniformidad de los protocolos y escalas de valoración, y la coincidencia respecto a las dificultades actuales.

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