{"id":117904,"date":"2018-03-11T10:47:38","date_gmt":"2018-03-11T10:47:38","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/eficacia-de-un-plan-de-autotratamiento-en-pacientes-con-epoc-en-la-reduccion-de-exacerbaciones\/"},"modified":"2018-03-11T10:47:38","modified_gmt":"2018-03-11T10:47:38","slug":"eficacia-de-un-plan-de-autotratamiento-en-pacientes-con-epoc-en-la-reduccion-de-exacerbaciones","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/eficacia-de-un-plan-de-autotratamiento-en-pacientes-con-epoc-en-la-reduccion-de-exacerbaciones\/","title":{"rendered":"Eficacia de un plan de autotratamiento en pacientes con epoc en la reducci\u00f3n de exacerbaciones"},"content":{"rendered":"

Tesis doctoral de Rub\u00e9n And\u00fajar Espinosa <\/strong><\/h2>\n

Resumen introducci\u00f3n y justificaci\u00f3n: la enfermedad pulmonar obstructiva cr\u00f3nica (epoc) presenta un incremento de preValencia y morbi-mortalidad, adem\u00e1s se estima que ser\u00e1 la tercera causa de muerte en el mundo y la quinta en a\u00f1os de vida perdidos con discapacidad. La epoc presenta una importante carga asistencial, impacto sociosanitario y econ\u00f3mico, deterioro de la calidad de vida y discapacidad. El actual modelo asistencial necesita una profunda revisi\u00f3n para incorporar elementos como educaci\u00f3n sanitaria, rehabilitaci\u00f3n, promoci\u00f3n del automanejo e implicaci\u00f3n del paciente en la toma de decisiones. Los planes de automanejo est\u00e1n dirigidos a la ense\u00f1anza de habilidades para optimizar el control de la enfermedad, la carga asistencial y la calidad de vida. En la epoc, el automanejo se ha estudiado menos que en otras enfermedades cr\u00f3nicas y los beneficios en la pr\u00e1ctica general son todav\u00eda inconcluyentes. \t \tobjetivo: valorar si un programa de automanejo en pacientes con epoc fr\u00e1giles, multicomponente y multidisciplinar reduc\u00eda la tasa de exacerbaciones graves frente a los cuidados habituales. material y m\u00e9todos: estudio prospectivo, multic\u00e9ntrico, controlado, aleatorizado y ciego simple. Seguimiento de 12 meses. Se reclutaron pacientes mayores de 50 a\u00f1os diagnosticados de epoc con al menos un ingreso hospitalario o atenci\u00f3n en urgencias por agudizaci\u00f3n en el a\u00f1o previo. Se excluyeron pacientes con deterioro cognitivo y f\u00edsico avanzado, comorbilidades severas e imposibilidad de leer textos. Se aleatorizaron en dos grupos: intervenci\u00f3n (gi), al que se les proporcion\u00f3 un plan de autotratamiento que consist\u00eda en un plan escrito de c\u00f3mo actuar ante los s\u00edntomas de agudizaci\u00f3n y para el manejo del tratamiento en la fase estable, adiestramiento en el uso de inhaladores y se les imparti\u00f3 una sesi\u00f3n educativa grupal por personal experto; y control (gc) al que se le entreg\u00f3 un manual de autoayuda para la epoc y se les aplicaron las medidas habituales de la pr\u00e1ctica cl\u00ednica. El seguimiento del gi estuvo compuesto por cuatro visitas y el del gc const\u00f3 de dos visitas. Se recogieron variables demogr\u00e1ficas, espirom\u00e9tricas y de tratamiento. La variable de resultado principal fue la tasa de exacerbaciones graves, las secundarias fueron hospitalizaciones, atenciones urgentes, d\u00edas de hospitalizaci\u00f3n, consumo de f\u00e1rmacos durante las exacerbaciones y mortalidad. \tresultados: de 250 pacientes reclutados, se aleatorizaron 96 con asignaci\u00f3n de 45 al gc y 51 pacientes al gi. Completaron el seguimiento 38 en gc y 47 en gi. La mayor\u00eda fueron hombres (78 casos (91,76%) con edad media 67,6 \u00c2\u00b1 6,9 a\u00f1os. No hubo diferencias significativas en cuanto a las caracter\u00edsticas basales. Tampoco en funci\u00f3n pulmonar, n\u00famero de pacientes con exacerbaciones, atenciones en urgencias por cualquier causa, hospitalizaciones, d\u00edas hasta el ingreso hospitalario, estancias hospitalarias, calidad de vida, ni uso de medicamentos durante las exacerbaciones. Existe una tendencia en la reducci\u00f3n del n\u00famero de pacientes con atenciones urgentes por agudizaci\u00f3n de la epoc en gi: (4 casos (36,8%) en el gc vs 9 pacientes (19,1%) en el gi (p=0,068)). Se observ\u00f3 una reducci\u00f3n significativa de la tasa de exacerbaciones graves en el gi: (1,37 (1,02 – 1,79) en el gc y 0,89 (0,64 – 1,21) en el gi (p=0,049), con una raz\u00f3n de tasas de 1,53 (1,01 – 2,29). No existieron diferencias en la mortalidad, observ\u00e1ndose 2 casos (5,4%) en el gc y ning\u00fan caso en el gi (p=0,191). \tconclusiones: el plan de autotratamiento (pat-epoc) en pacientes con epoc fr\u00e1giles redujo significativamente la tasa de exacerbaciones graves al a\u00f1o de su aplicaci\u00f3n. El pat pudo aplicarse en menos de la mitad de la poblaci\u00f3n seleccionada, lo que sugiere que s\u00f3lo una subpoblaci\u00f3n de pacientes con epoc fr\u00e1gil puede beneficiarse de este tipo de intervenciones. palabras clave: epoc, automanejo, autotratamiento, exacerbaci\u00f3n. summary introduction and rationale: chronic obstructive pulmonary disease (copd) is displaying an increased prevalence and increased morbidity and mortality, in addition to which it is estimated that it will be the third leading cause of death worldwide and the fifth in terms of years of life lost due to disability. Copd is associated with a major care burden, an economic, social and health care impact, a deterioration in the quality of life and disability. The current management model needs to be thoroughly revised to incorporate aspects such as health education, rehabilitation, encouragement of self-management and involvement of the patient in decision-taking. Self-management plans are geared to teaching skills to optimise disease control, care burden and quality of life. Self-management has been less studied in copd than in other chronic diseases and the benefits in general practice are still unclear. \t \tobjective: to evaluate whether a multicomponent and multidisciplinary self-management programme in frail patients reduces the rate of severe exacerbations compared with usual care. material and methods: prospective, multicentre, controlled, randomised, single-blind study. Twelve-month follow-up. Patients over 50 years of age diagnosed with copd with at least one hospital admission or emergency department visit due to exacerbation in the previous year were recruited. Patients with advanced cognitive and physical impairment, severe comorbidities and an inability to read texts were excluded. They were randomised to two groups: intervention (ig), which was issued with a self-treatment plan consisting of a written plan of what to do in the event of symptoms of exacerbation and how to manage the treatment in the stable phase, instructed in the use of inhalers and given a group education session by expert staff; and control (cg), which was handed a self-help manual for copd and administered the usual clinical practice measures. Follow-up of the ig comprised four visits and that of the cg consisted of two visits. Demographic, spirometric and treatment variables were collected. The primary outcome variable was the rate of severe exacerbations and the secondary outcome variables were hospitalisations, emergency management, days of hospitalisation, consumption of drugs during exacerbations and mortality. \tresults: of 250 patients recruited, 96 were randomised, with 45 being assigned to the cg and 51 patients to the ig. Thirty-eight in the cg and 47 in the ig completed the follow-up. The majority were men (78 cases (91.76%)) with a mean age of 67.6 \u00c2\u00b1 6.9 years. There were no significant differences in terms of baseline characteristics, nor in lung function, number of patients with exacerbations, emergency management for any reason, hospitalisations, days until hospital admission, hospital stays, quality of life or use of medication during exacerbations. There is a tendency to a reduction in the number of patients with emergency management due to exacerbation of copd in ig: 4 cases (36.8%) in the cg vs 9 patients (19.1%) in the ig (p = 0.068). A significant reduction in the rate of severe exacerbations was observed in the ig: 1.37 (1.02 – 1.79) in the cg and 0.89 (0.64 – 1.21) in the ig (p = 0.049) with a rate ratio of 1.53 (1.01 – 2.29). There were no differences in mortality, two cases (5.4%) being observed in the cg and none in the ig (p = 0.191). \tconclusions: the self-treatment plan (stp-copd) in frail patients with copd significantly reduced the rate of severe exacerbations in the year of its application. The stp could be applied in less than half the selected population, which suggests that only a subpopulation of frail patients with copd can benefit from this type of intervention. keywords: copd, self-management, self-treatment, exacerbation.<\/p>\n

 <\/p>\n

Datos acad\u00e9micos de la tesis doctoral \u00abEficacia de un plan de autotratamiento en pacientes con epoc en la reducci\u00f3n de exacerbaciones<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 Eficacia de un plan de autotratamiento en pacientes con epoc en la reducci\u00f3n de exacerbaciones <\/li>\n
  • Autor:<\/strong>\u00a0 Rub\u00e9n And\u00fajar Espinosa <\/li>\n
  • Universidad:<\/strong>\u00a0 Murcia<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 16\/07\/2015<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Juan Miguel Sanchez Nieto<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: xavier Mu\u00f1oz gall <\/li>\n
        • Luis Manuel Hern\u00e1ndez blasco (vocal)<\/li>\n
        • (vocal)<\/li>\n
        • (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de Rub\u00e9n And\u00fajar Espinosa Resumen introducci\u00f3n y justificaci\u00f3n: la enfermedad pulmonar obstructiva cr\u00f3nica (epoc) presenta un incremento de […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[9,69,139,8235],"tags":[90279,232075,232074,159267],"class_list":["post-117904","post","type-post","status-publish","format-standard","hentry","category-ciencias-medicas","category-enfermedades-pulmonares","category-medicina-interna","category-murcia","tag-juan-miguel-sanchez-nieto","tag-luis-manuel-hernandez-blasco","tag-ruben-andujar-espinosa","tag-xavier-munoz-gall"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117904","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117904"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117904\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117904"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117904"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117904"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}