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Gestión de la multimorbilidad utilizando un modelo de atención centrado en el paciente: un ensayo pragmático
Chris Salisbury1, Mei-See Man1, Peter Bower2
1Centre for Academic Primary Care, NIHR School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Lancet (London, England)
|July 3, 2018
Resumen
El enfoque 3D centrado en el paciente no mejoró la calidad de vida de los pacientes con múltiples afecciones crónicas. Este gran ensayo no encontró diferencias significativas en comparación con la atención habitual para el manejo de la multimorbilidad.
Área de la Ciencia:
- Gerontología
- Salud pública
- Investigación en servicios de salud
Sus antecedentes:
- La gestión de múltiples enfermedades crónicas (multimorbilidad) plantea desafíos a los sistemas de salud.
- El consenso internacional aboga por una atención centrada en el paciente, centrada en la calidad de vida y la autogestión.
- La evidencia de la eficacia de los enfoques centrados en el paciente en la multimorbilidad es limitada.
Objetivo del estudio:
- Para probar la hipótesis de que el enfoque 3D centrado en el paciente mejora la calidad de vida relacionada con la salud en pacientes con multimorbilidad.
- El enfoque 3D considera las dimensiones de la salud, la depresión y las drogas.
Principales métodos:
- Ensayos pragmáticos aleatorizados por grupos en prácticas generales inglesas y escocesas.
- 33 clínicas asignadas aleatoriamente a la atención habitual o a las revisiones tridimensionales cada 6 meses.
- Se reclutaron 1546 adultos con multimorbilidad; el resultado primario fue la calidad de vida (EQ-5D-5L) a los 15 meses.
Principales resultados:
- No hubo diferencias significativas en la calidad de vida entre el grupo de intervención 3D y el grupo de tratamiento habitual (diferencia ajustada 0,00, IC del 95% -0,02 a 0,02; p=0,93).
- El ensayo incluyó a 1546 pacientes en 33 consultas generales.
- Las muertes de pacientes no estuvieron relacionadas con la intervención.
Conclusiones:
- La intervención 3D, basada en el consenso internacional para el manejo de la multimorbilidad, no mejoró la calidad de vida de los pacientes.
- Este estudio representa una amplia investigación sobre el manejo óptimo de la multimorbilidad.
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