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. 2008 Nov 18;37(4):221–230. [Article in Spanish] doi: 10.1157/13085953

¿Podemos mejorar el tratamiento y el control de las enfermedades crónicas?

Can we improve management and control of chronic diseases?

D Yánez-Cadena 1, A Sarría-Santamera 1,⁎, F García-Lizana 1
PMCID: PMC7679849  PMID: 16545267

Abstract

Objetivo

Investigar la efectividad de diferentes estrategias destinadas a mejorar la calidad y los resultados de las intervenciones en el tratamiento de las enfermedades crónicas.

Metodología

Revisión sistemática de la bibliografía.

Criterios de inclusión

Ensayos clínicos en lengua inglesa o española que evalúen la efectividad de distintas intervenciones para mejorar los resultados asistenciales del asma, la diabetes, la hipertensión y la insuficiencia cardíaca. Las intervenciones se clasifican de acuerdo con un modelo conceptual en 6 categorías: cambios organizativos, participación comunitaria, sistemas de información, diseño de la práctica clínica, apoyo a la toma de decisiones y de autocontrol. Los resultados evaluados fueron: utilización de servicios de salud, tratamiento clínico, resultados clínicos, calidad de vida, satisfacción e indicadores de capacidad de autocontrol.

Resultados

Se incluyeron 37 estudios que incorporaban 38 intervenciones. Las intervenciones más frecuentes son las que investigan los cambios en el de diseño asistencial, seguidas de las que analizan el efecto de los sistemas de información y apoyo a la toma de decisiones. Las intervenciones más complejas en número de intervenciones, incluido el apoyo para el autocontrol, mostraron una mayor probabilidad de tener efectos positivos en el tratamiento y en los resultados clínicos. Pocas intervenciones consiguen mejoras en utilización de servicios, aunque sí se observaron sustanciales mejoras en los resultados percibidos.

Conclusiones

Para mejorar la calidad asistencial y la efectividad en el control de las enfermedades crónicas es preciso adoptar una visión sistemática que incluya un sistema sanitario proactivo y pacientes protagonistas activos del tratamiento de su enfermedad. Los programas así diseñados deben combinar, al menos, estrategias organizativas, de diseño asistencial y de autocontrol.

Palabras clave: Atención primaria, Calidad asistencial, Efectividad, Enfermedades crónicas

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