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2.
Int J Integr Care ; 15: e025, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26150763

RESUMO

INTRODUCTION: The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011-2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. METHOD: The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. RESULTS: It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. DISCUSSION: The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.

4.
Aten. prim. (Barc., Ed. impr.) ; 44(2): 107-113, feb. 2012.
Artigo em Espanhol | IBECS | ID: ibc-97938

RESUMO

El envejecimiento de la población y el aumento de personas con enfermedades crónicas constituye un escenario que plantea importantes retos en la manera como organizar y prestar los servicios para este grupo de población. Existen ya experiencias y evidencia que nos ayudan a repensar qué aspectos claves deberían ser tenidos en cuenta para diseñar un modelo sanitario sensible y orientado a este nuevo paradigma. El enfoque clínico asistencial por sí mismo es importante pero a su vez limitado; se requiere de un abordaje multidimensional donde se incorporen elementos diferentes como verdaderas palancas de cambio: qué aportación pueden realizar los sistemas de información, qué objetivos deben asignarse de manera transversal a diferentes organizaciones y profesionales, qué competencias clínicas y relacionales deberían contemplarse en los planes de formación y desarrollo de competencias o cómo se debe financiar la provisión. Además, sólo interactuando con varios de estos elementos se podrá llevar a cabo un cambio significativo en la atención a los pacientes crónicos, especialmente a aquellos que están en situación de mayor complejidad y vulnerabilidad(AU)


The ageing of the population and the increase in people with chronic illnesses is a scenario that creates important challenges on how to organise and provide services for this population group. There is already experience and evidence that would help us to re-think about what are the key aspects that should be taken into account to design a simple health model directed towards this new paradigm. The clinical care approach in itself is important, but at the same time, limited. A multidimensional approach is required where different elements, such as real platforms for change, are incorporated; the contribution that can be made by information systems, the objectives that should be assigned cross-sectionally to different organisations and professionals, the clinical and relational skills that should be contemplated in training and skill development plans or how the provision should be financed. Also, only interacting with some of these elements could give rise to a significant change in the care of chronic patients, particularly those in a highly complex and vulnerable situation(AU)


Assuntos
Humanos , Masculino , Feminino , Serviços de Saúde/ética , Serviços de Saúde/legislação & jurisprudência , Condutas Terapêuticas/educação , Condutas Terapêuticas/legislação & jurisprudência , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/economia , Serviços de Saúde , Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/normas , Condutas Terapêuticas/normas , Condutas Terapêuticas/organização & administração , Dinâmica Populacional , Doença Crônica/tratamento farmacológico , Doença Crônica/terapia
5.
Aten Primaria ; 44(2): 107-13, 2012 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-21636176

RESUMO

The ageing of the population and the increase in people with chronic illnesses is a scenario that creates important challenges on how to organise and provide services for this population group. There is already experience and evidence that would help us to re-think about what are the key aspects that should be taken into account to design a simple health model directed towards this new paradigm.The clinical care approach in itself is important, but at the same time, limited. A multidimensional approach is required where different elements, such as real platforms for change, are incorporated; the contribution that can be made by information systems, the objectives that should be assigned cross-sectionally to different organisations and professionals, the clinical and relational skills that should be contemplated in training and skill development plans or how the provision should be financed. Also, only interacting with some of these elements could give rise to a significant change in the care of chronic patients, particularly those in a highly complex and vulnerable situation.


Assuntos
Doença Crônica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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