AUTHOR=Soldado-Matoses María S. , Caplliure-Llopis Jordi , Barrios Carlos 

TITLE=Effectiveness of a home health monitoring and education program for complex chronic patients, led by primary care nurses

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1281980

DOI=10.3389/fpubh.2023.1281980

ISSN=2296-2565

ABSTRACT=Background: The challenge of chronicity has led developed countries to design strategies to respond to thenew needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate.
Methods: A quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG). 
Results: Along the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68; p<0.001). Admissions in the first and second year of the study period were lower in the intervention group p=0.002 and p<0.001 respectively). All the participants in the control group were admitted at least once during the study period. In contrast, 29.0% of the participants in the intervention group never had a hospital admission during the 3-years study period. The number of ED visits to the emergency department was significantly lower in the IG during the three years of the study periods. The cumulative number of emergency visits in the IG was half that in the CG (5.66 ± 4. vs. 11.11 ± 4.45; p<0.001, Cohen’d:1.53). The 3-year overall mortality rate was 30.6% in the control group and 25.3% in the nursing home visit program. These differences were not statistically significant.
Conclusion: The program demonstrated its effectiveness in reduction of hospital admissions and visits to the emergency department. The program had no impact on mortality rate. This program of home visits reinforces the role of primary care nurses in advanced competencies in chronicity.