Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation.

Autor: Ortiz MM; Unidad de Calidad, Hospital Universitario de Fuenlabrada, Madrid, España; Asociación Madrileña de Calidad Asistencial, Madrid, España., Llamas P; Hematología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España., Sanmartín M; Cardiología, Hospital Ramón y Cajal, Madrid, España., Egido JA; Neurología, Hospital Clínico San Carlos, Madrid, España., Del Toro J; Medicina Interna, Hospital Gregorio Marañón, Madrid, España., Egocheaga MI; Medicina de Familia, Centro de Salud Isla de Oza, Madrid, España., Estévez MS; Enfermería, Hospital Universitario Fundación Alcorcón, Madrid, España., Navarro IM; Universidad Miguel Hernández de Elche, Alicante, España. Electronic address: inavarro@umh.es., Mira JJ; Universidad Miguel Hernández de Elche, Alicante, España; Departamento de Salud Alicante-Sant Joan, Alicante, España; REDISSEC Red Enfermedades crónicas, Madrid, España.
Jazyk: English; Spanish; Castilian
Zdroj: Revista clinica espanola [Rev Clin Esp (Barc)] 2017 May; Vol. 217 (4), pp. 181-187. Date of Electronic Publication: 2017 Mar 28.
DOI: 10.1016/j.rce.2017.02.014
Abstrakt: Objective: To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation.
Method: The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus.
Results: We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient.
Conclusion: The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.
(Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
Databáze: MEDLINE
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