social profile of patients with complex chronic (pcc) diseases. the

Transcripción

SOCIAL PROFILE OF
PATIENTS WITH
COMPLEX CHRONIC
(PCC) DISEASES.
THE PCC SOCIAL
EVALUATION
English version summary
Original document:
“EL PERFIL SOCIAL DEL PACIENT CRÒNIC COMPLEX (PCC).
VALORACIÓ SOCIAL DEL PCC”
EL TREBALL SOCIAL SANITARI EN L'ATENCIÓ AL PACIENT
CRÒNIC COMPLEX (PCC). Institut Català de la Salut. Abril 2015
SOCIAL PROFILE OF PATIENTS WITH COMPLEX CHRONIC (PCC) DISEASES. THE PCC SOCIAL EVALUATION
1
SOCIAL PROFILE OF PATIENTS WITH COMPLEX CHRONIC DISEASES. THE PCC
SOCIAL EVALUATION.
Authors
Peña Ocaña, M. del Mar; Canet i Ponsa, M. Mercè; Montull Castañ, Ana; Diaz Duran, Helena Mª;
López Cervelló, Rosa; Sánchez Albarracin, Lourdes; Olmos Pagès, M Dolors; Salvat Salvat, Olga; Rojo
Gené, Ramon Angel; Clot Guitart, M. Montserrat; Basagaña Sellabona, Susana; Rocabayera Andreu,
M. Antònia; Rodríguez Molinet, Pepita; Gil Bargallo, Cristina; Medina Girona, Alicia; Rodríguez Sanz,
Lorena; Rovira Aler, Carme; Segarra Fores, Rosa; Muniente Pérez de Tudela, Glòria; Altuna Laiseca,
Inés; Carrasco Coria, Rosa; Fort Consul, Jaume; Peña Gallardo, Conchita; Pérez Navarro, Rosa M;
Fernandez Ortega, Eva; Solanas Bacardit, Gemma; Soler Soto, Sandra; Vergés Canivell, M. Lluïsa; Bret
Garriga, Montserrat; Altuna Laiseca, Inés.
(English version: Helena M. Diaz Duran)
Key words:
Health social work, Complex Chronic Diseases, social data, social valuation
Abstract
The analysis of the social and family data in Patients with Complex Chronic Diseases shows that as
long as a health progressive loss occurs certain social problems that produce unease in patients and
their families arise. Those social problems and their psychosocial derived malaise interfere in the
optimum approach of the health problem of the health services and require interventions in the
social field on health with the purpose of:



Working on improving the health-related life quality of patients with chronic diseases, their
families and their social environment.
Working for the optimum / appropriated balance and stability of the social functioning to
face the health problem from the daily personal / familiar sustainability.
Contributing to the proper use of the health services.
In Primary Care, the proactive social work in the PCC frame is a preventive work line that anticipates
the socio familiar events and determinates the social factors that will be taking part with the ageing
and the needs that will appear.
The proactive work also allows identifying hidden social risk situations contributing to prevent and
decrease social and health expenditure. Furthermore, it increases the patient satisfaction with regard
to the all-round services provided.
In hospital care, the social programs of systematic attentions represent the key axis of the all-round
attention. The approach of the social risk in health at hospital care is the key to guarantee the
continuum healthcare and reduce the worsening risk of the health situation. The social intervention
in hospital becomes relevant in debut situations with complex chronicity due to a traumatic origin or
high clinic complexity pathologies.
In the health social dimension of PCC takes value the multidisciplinary approach with the specific
social view, very close to the sanitary look inside the sanitary institution itself.
2
INTRODUCTION___________________________________________________
The evolution and the efforts of the health social view of contributing to improve in quality and
efficiency on caring the chronic complex patients require an analysis of their social profiles.
Social workers serving in health institutions contribute the social view of the health within the
integrated model of caring health. They work systematically with chronic complex patients in a
proactive frame to detect and anticipate the social risk situations or social needs/ psychosocial needs
that difficult the health attention.
Anticipating the patients' complex social situations facilitates both the sanitary institution and the
professionals –in their different levels of assistance- their predictive work to carry out with the
patients.
For patients, the contribution of an advanced social diagnosis together with a defined and managed
intervention plan minimizes the impact that a complex health situation or a sudden dependency
could have on the patients' social situation. Simultaneously, this kind of planned diagnosis and
interventions could improve their life quality and the satisfaction of their needs.
After two years of proactive social work in the Insitut Català de la Salut (ICS) with PCC there have not
been found empiric data related with chronic patients within the social sphere that express in their
profile aspects and specific variables to take into account to advance in the health social dimension.
The health problems affect the social functioning of the person and this can carry new health
problems or their worsening. Therefore, health and social functioning are tightly linked, they affect
each other reciprocally.
In the chronic patients care, the health needs, besides being taken care from the integrative
conceptualization where social view is already present, also it should be approached in an integrated
way between the health system and the social care system.
During 2013 and 2014 health social workers in ICS - systematically in Primary Care in the quality
standards framework (Estàndard de Qualitat Assistencial, EQA) defined in ICS and in hospital care
according to the institutional objectives - carried out valuations and interventions to the PCC. In
order to know the reality of these patients and being able to improve the services offered to them improving the social view of the health - it is necessary to analyze the social data compiled in the
fulfilled social valuations.
The information provided by the health social workers will contribute to redefine and develop those
areas of the social aspects of health and their specific services letter for the chronic patients that
could require them. At the same time, they will help to improve the quality of the activity / services
of social work in ICS.
What is the profile and the social situation of the chronic patients valuated and looked after for the
health social workers? Which kind of social functioning do they have, in relation to the health
situation they already have? What improvements in social attention can be proposed in a close
future, attending to their profile and reality? These questions are the ones suggested in on this
present analysis.
3
OBJECTIVES_______________________________________________________
1. Describe the social situation and the social functioning related to the chronic patients’ health.
2. Identify opportunities to improve the attention of the social needs of the chronic patients.
WORK PLAN______________________________________________________
1. SELECTION CRITERIA OF THE SAMPLE
PRIMARY CARE
Expected Sample: 1840 PCC cases analyzed by 184 health social workers.
The PCC are selected from the EQA TS5 list from each one of the health social workers in Primary
Care all around Catalonia (184). Every social worker is asked to analyze the data related with their 10
first patients in the EQA TS5 list on January 2014.
HOSPITAL CARE
Expected Sample: Analysis on 96 patients PCC realized by the social work services in the 8 ICS
hospitals (Josep Trueta, Germans Tries, Vall d’Hebron, Bellvitge, Viladecans, Joan XXIII, Arnau de
Vilanova and Verge de la Cinta).
The PCC are selected when consultations are received to the social work services, following their
arrival order.
2. INSTRUMENT


Anonymous and individual form in orther to collect data of every patient, in a virtual platform.
Help guide to collect data.
The resultant information of the defined variables in each section will gather the social
characteristics of PCC on both care levels: Primary Care and Hospital Care.
The questionnaire is divided in 4 sections: Health area data, Social area data, psychosocial area data:
social unrest expressed, and the social work intervention data.
3. VARIABLES
To define the variables it has been taken into account the disciplinary contents of social valuation of
PCC and the recommendations of the document "The health social work in the chronic patient care".
4
4. DISCUSSION GROUP
In order to analyze the data 3 independent discussion groups have been defined. The first discussion
group was composed by 10 professionals from all over Catalonia that took part in a corporative
group of "registration system and social work information". The second group was defined to
execute the discussion and was composed by 5 professionals with research experience. The third
group was composed by the social work referents at ICS in a mixed commission.
Methodology:
The discussion duration for each group was about 5 hours. It has been given one month interval
between the first discussion group and the second one. And there was a three months period
between the second and the third. All of them had a moderator / reporter. Data collection from
groups has been registered in written records. Information was compiled manually and transcripted
afterwards. Then, they were codified in order to be able to analyze them. In all three groups the
same methodology has been followed.
The discussion order of the speakers, proposed by the group coordinator, allowed spontaneity in the
group.
Both the generic ideas about the health social work practice and the social intervention with PCC,
and specific ideas about each variable analyzed with the individual point of view of every participant
have been exchanged in the discussion groups.
5
PROJECT RESULTS__________________________________________________
PCC GENERAL DATA
Profile: By age, at Primary Care the 55% are over 80 years old. At Hospital Care 35% are over 80 years
old.
The main location of the patients at hospital is at internal medicine and orthopedic surgery areas
(87%). The medical discharge destination use to be private residence or socio-sanitary service (43%).
HEALTH AREA DATA
Team that look after the PCC on their last month of life: 63% by Primary Care Team. Complexity
stratification, the Clinic Risk Group (CRG): grouper CRG 6 used in 64% of the cases. Dependency /
autonomy measured with Barthel Test: 12% severe dependency or total dependency in Primary Care,
40% in Hospital Care.
SOCIAL AREA DATA
Case detection by proactively 100% Primary Care, in Hospital Care 68% are detected by
consultations.
Fragility indicators: Social network: Living alone 32% in Hospital Care and 18% in Primary Care.
Without caregiver or reference person: 19% in Primary Care, 26% detected in Hospital Care.
Indicators for economic dependency / risk of exclusion: Economic vulnerability having between
Minimum Wage (MW) and the mount of a Non Contributory Pension (NCP) - In Catalonia it means
between 649 - 370 €/month-: 24% detected in Primary Care and 30% detected in Hospital Care.
Living on the street 8% detected in Hospital Care.
Social indicators for Dependency: 24% detected in Primary Care and 27% in Hospital Care already
have a Certificate of Disability. 37% of PCC in Primary Care and 33% in Hospital Care already have
recognized a Dependency Degree.
Social indicators for Social Care: 38% PCC in Primary Care and 78% PCC in Hospital Care had some
relation with social services in the last two years. At the analysis moment, there were followed up by
social services the 24% PC and 40% HC.
Psychosocial area: 39% PCC in Primary Care express unease about their health due to inability to
manage the daily lack of health.
Social valuation: Social functioning with risk indicators to attend their own health 30% in Primary
Care and 44% in Hospital Care. Moreover, 5% in Primary Care and 21% in Hospital Care present some
social dysfunction.
6
DISCUSSION______________________________________________________
There is a distinct PCC social profile between Primary Care and Hospital Care.
As more social complexity, more complex becomes the health situation or the patient can live more
worsening episodes.
The proactive contact, in Primary Care or by consultation, distinct and will condition a social
intervention either predictive or reactive. In acute care, at consultation to the social workers, it is
done a previous social triage based in defined social risk indicators. The situations that need to be
socially predicted will not be taken in account as they can become more percentage of social crises at
the hospital discharge.
At Primary Care patients present less cognitive impairment. So, the work plan consists in a preventive
work and following up the diseases that will increase as the ageing does.
At the hospital, patients already appear with their pathologies whether they have just appeared or
because they have developed an acute process and there can be changes within their social and
family environment.
Poverty tax is higher in patients that turn to hospital than those who are attended at Primary Care.
Population profile is medium-low class with incomes, per residential units, around one thousand
Euros. In a high percentage of the cases, the family incomes only proceed from the patient pension.
Related to the social risk indicators and the social functioning with risk indicators, during the
discussion it has given a consensus about the "spheres of social risk" for caring and health attention
in the PCC own social familiar environment. The risk indicators areas that base the social diagnosis
and the social intervention, incorporated in the social valuation at the multidisciplinary therapeutic
plan, are:
1.
2.
3.
4.
5.
6.
Organization of the care area
Family unit area
Family cohesion and affective clime area
Structural conditions, security, comfortability and privacy area
Environment area
Relational network area
Organization of the care area
 Difficulties in the sphere of the caregiver: Absence of caregiver, ineffective caregiver,
caregiver with fragile health...
 Difficulties in the material and economic support.
Family unit area


Weak family unit: member with toxic habits, young sufferer, single-parent family, singleparent family with dependent minors, etc.
Complex relations between some of the members in the family unit: Toxic relations, trauma,
etc.
7



Elderly head of household and developing a caregiver role.
Disagreement in the decision / intention of the patient / family about the place where to be
cared and to die.
Precedent of mistreatment
Family cohesion and affective clime area


Affective disaffection, affective detachment, rejection, etc.
Imposition of the care, caring as a duty, caregiver compelled, and dependent caregiver
(psycho emotionally, economically or socially)...
Structural conditions, security, comfortability and privacy area






Marginality
Home rotation (itinerant patient)
Difficulty in/for the house adjustment to the minimums required for the home care needed.
Living space / personal space inadequate or precarious.
Living space / personal space uninhabitable for extreme unhealthiness
Destitution
Environment area


Socio geographic isolation
Insurmountable architectural barriers.
Relational network area



Uprooting due to displacement from the place of origin.
Absence of social support network.
Distinguishing aspects in care, customs, beliefs, language, etc.
CONCLUSION_____________________________________________________
PCC have a distinct social profile depending on whether they are attended at Primary Care or at
Hospital Care (social profile more complex).
The proactive health social work in PCC is a preventive work line that anticipates to daily social risk
factors and to the socio familiar events in health care and contributes to the proper use of the
services and to the patients’ satisfaction.
Disciplinary consensus exists about the social risk spheres in PCC.
8
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social profile of patients with complex chronic (pcc) diseases. the

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