Dissertation

Impacte del Nivell Socioeconòmic en Pacients amb Insuficiència Cardíaca Crònica: Anàlisi en la Població General de Catalunya en Pacients Atesos en un Programa Integral d’Excelꞏlència

Capdevila Aguilera, Cristina

2024

Overview

INTRODUCTION INTRODUCTIONIt is well known that Heart Failure (HF) is a very prevalent pathology and one of the main causes of the need for healthcare resources in our population, since clinical management is complex and often difficult to approach.It is for this reason that in recent decades, strategies have been sought, within the framework of the management of chronic diseases, to provide these patients with comprehensive and integrated care, achieving in these cases an improvement in clinical outcomes, such as mortality, readmissions and emergency room visits with the consequent impact on efficiency.However, assessing the impact of social determinants of health such as socioeconomic level (SES) on patients with Heart Failure is one of the challenges we have as a healthcare system and is what we are addressing in the following doctoral thesis.HYPOTHESIS HYPOTHESISIt is possible that low NSE negatively impacts the use of healthcare resources and clinical events in patients with CHF despite the universal access to healthcare that our healthcare system provides. However, it is possible that the effectiveness of comprehensive care programs for CHFis obtained independently of NSE but is partially attenuated by this factor.OBJECTIVES OBJECTIVESIn this project we propose as main objectives 1) to describe the association between NSE and clinical events in patients from the general population of Catalonia with CHF, 2) to evaluate the impact of NSE on the effectiveness of a comprehensive multidisciplinary program of transitional care for patients with CHF.We want to know the impact that these projects with territorial scope that integrate services and provide an integrated response can have and, at the same time, to be able to evaluate whether socioeconomic level (NSE) isone of the determining factors that can mean that these programs, which are difficultto implement and costly, work or not, since it could be thought that a low socioeconomic level is a vulnerability factor in these patients that implies having worse results and thatdepending on the socioeconomic level of the population treated, the deployment of the programs should be oriented differently.To answer this question of the impact of low socioeconomic status as a vulnerability factor and assess the management strategy in patients with heart failure, we proposed this thesis.RESULTS RESULTSIn the first work of the doctoral thesis, we carry out a descriptive study of the entire population with a diagnosis of HF in Catalonia during 2016, evaluating the NSE and analyzing the need for healthcare resources, such as urgent consultations, the need for hospital admission, and mortality.In the second work, we study patients with HF in the community reference area of ​​our hospital for 5 years, before, during, and after the implementation of a heart failure program that integrates hospital and primary care resources, with a transitional approach based on multidisciplinary and self-care. We evaluate the impact on health outcomes of this implementation by comparing ourselves with the rest of Catalonia both globally and stratified according to NSE.The data obtained suggest, on the one hand, that in patients with CHF, the NSE determines the evolution and use of healthcare resources, experiencing higher mortality, a decrease in life expectancy and with a greater use of unplanned urgent healthcare resources and a lower use of outpatient (preventive) healthcare resources. On the other hand, it is found that the benefit of the implementation of a community-based integrated care program for CHF, based on transitions of care and with case management as the driving force of the model, is obtained independently of the NSE of the patient, that is, the benefits of these programs are for all patients regardless of the NSE, especially in terms of mortality, but a gap does open, since the magnitude of the benefit seems to be slightly lower in the lower NSE strata in terms of the risk of hospitalizations. CONCLUSIONS CONCLUSIONSWith the data from the first study we can conclude that in patients with CHF with access to universal healthcare, lower income was independently associated with higher mortality and lower use of outpatient healthcare resources. The findings suggest that patients with CHF could benefit from a systematic assessment of their socioeconomic status and that this may help to identify vulnerable subgroups that can benefit from more personalized health education and management. On the other hand, the second study allows us to conclude that comprehensive multidisciplinary care programs for HF improve clinical outcomes, both in general and in all strata of NSE, although the effect of improvement in hospitalization in patients with CHF is partially attenuated in low or very low NSE strata.

• Publisher: ProQuest Dissertations & Theses
• Subject: Medicine / Pathology
• ISBN: 9798314827536