Análisis de un modelo de asistencia clínica compartida con internistas en un servicio de cirugía vascular Analysis of a comanagement clinical model with internists in a vascular surgery department

Objective: to assess whether clinical comanagement between vascular surgeons and internists improves the quality of care provided to patients admitted to a vascular surgery service. Material and method: several clinical features related to the clinical care provided to a sample of patients with arterial disease and DVT admitted to the vascular surgery at Lucus Augusti University Hospital of Lugo were analyzed, after implementation of a comanagement model of care involving internists during the year 2013. Data of patients with DVT were compared with historical controls of the year before. Moreover, we conducted a satisfaction survey to the medical staff and nursing of the vascular surgery service about their preferences regarding the model of clinical care. Results: 50 patients with arterial disease and 75 with DVT (25 cases and 50 controls) were studied. Among the former, mean age was 71.9 years (SD 14), 60% male. They received an average of 8.2 drugs (SD 4.4), the Charlson index was 4.1 (SD 2.7) and the Barthel index 85.9 (SD 20). 70% had anemia at admission and 86% experienced in-hospital complications, with a mortality of 10%. DVT patients attended by the comanagement model showed a higher frequency of identified risk factors for thrombosis (76% vs 38%, p = 0.002), proper adjustment of the dose of LMWH to weight and renal function (92% vs 18%, p = 0.0001) and complete record of comorbidity (100% vs 50%, P = 0.0001), with no differences in length of hospital stay. Both medical staff and the nursing preferred the comanagement model with respect to the standard model. Conclusions: patients with arterial and venous disease have a risk of complications and comorbidity that justify the participation of internists in their clinical care. The comanagement model can improve the quality of care provided, with a high degree of satisfaction among the staff of the surgical team.