Juan Carlos Contel

La atención al paciente crónico en situación de complejidad: el reto de construir un escenario de atención integrada

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.

Selection of the method to appraise and compare health systems using risk stratification: the ASSEHS approach

To face the challenge of active and healthy ageing, European Health Systems and services should move towards proactive, anticipatory and integrated care. The comparison of methods to combine results across studies and to determine an overall effect was undertaken by the EU project ASSEHS (Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services, EU project (No. 2013 12 04). The questions raised in ASSEHS are broad and involve a complex body of literature. Thus, systematic reviews are not appropriate. The most appropriate method appears to be scoping studies. In this paper, an updated method of scoping studies has been used to determine the questions needed to appraise the health systems and services for frailty in the ageing population. Three objectives were set (i) to detect a relevant number of risk stratification tools for frailty and identify the best-in-class, (ii) to understand the feasibility of introducing stratification tools and identify the difficulties of the process and (iii) to find evidence on the impact of risk stratification in Health Services. This novel approach may provide greater clarity about scoping study methodology and help enhance the methodological rigor with which authors undertake and report scoping studies.

Protocol for regional implementation of community-based collaborative management of complex chronic patients

Supported by CONNECARE (H2020-PHC-2015, Grant no. 689802), PITES (FIS-PI15/00576), SELFIE (H2020, Grant no. 634288), and NEXTCARE (RIS3CAT), Generalitat de Catalunya (2014SGR661), and CERCA Programme / Generalitat de Catalunya

Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.

IEXPAC website for measuring advances in People-Centred and Integrated Care in healthcare organizations

Introduction : Systematic assessment of patient experience (PE) might contribute to transform the patient-professional interaction model and to improve outcomes. This type of assessments stems from the recognition of the person’s rights and, therefore, of his/her active role in their wellbeing. It is a promising alternative to the fruitless efforts of the traditional approaches to achieve patient’s participation in the design of care processes. Patient Experience describes results from the patient viewpoint when receiving care in relation to the interaction with professionals (relational aspects) and to the care process in which the person is involved (functional aspects). PE measure allows the assessment of how health and social care providers are organized to satisfy patient needs in each moment adequately. In this type of measurements, elements such as integrated care, personalized care plans, recognition of patient’s role in their own health (co-production) or communication adapted to patient’s needs and personal circumstances are crucial. IEXPAC (Instrumento de Evaluacion de la eXperiencia del Paciente Cronico in Spanish, (see www.iemac.org/iexpac) is a 12 structured items scale with a 0-10 points-scale response that allows to assess the experience of a chronic patient. It has been validated in Spain considering ceiling and floor effects, reliability and face and construct validity. IEXPAC converged into 3 factors exploring: (1) the type and scope of patient and professionals interactions oriented to patient activation; (2) the patient’s self-management capacity of his/her wellbeing thanks to the interventions received and (3) new relational model of the patient with the system through internet or with partners in group interventions. This scale has its origin in the instrument IEMAC/ARCHO (Assessment of Readiness for Chronicity of Health Care Organizations, see www.iemac.org), designed to monitor progress of health and social care organizations towards an integrated, person-centered chronic care model. To facilitate the introduction of patient experience assessment in the evaluation procedures of health and social care organizations, a website was designed. IEXPAC website is accessible to patients from different profiles of users, as healthcare institutions, providers, patients’ associations or research’s teamwork. The objective of the current study was to evaluate the usefulness and user friendliness of the IEXPAC website, and the use of IEXPAC scale. Methods : The IEXPAC website (http://www.iemac.es/iexpac/default.asp) was designed for Chrome, Explorer, Safari, Firefox, Edge and to allow the introduction and recovery of data regarding one or several evaluations. Comparisons inter and intra evaluations are available so users obtain useful information to introduce changes to improve care. This website suggests recommendations about how to conduct studies in several contexts. The IEXPAC website was assessed exploring its friendliness, usefulness, and impact to introduce changes. Assessments were performed with self-assessed, online, standardized questionnaires. The number of users and downloads were also considered. Results : Preliminary results render an average rating in the IEXPAC scale of 5.7 points (SD 0.7, IC95% 3.0-3.2). Average rating for each factor is: 7.7 (SD 0.9) for factor 1; 7 (SD 0.9) for factor 2, 2.5 (SD 0.9) for factor 3. New integrated care models incorporate people’s needs, preferences and expectations. IEXPAC participates of this approach emphasizing, for instance, the need to improve patient’s active participation in their therapeutic and care plan by agreeing health targets with his/her professionals (item 6, rated 6.85, SD 1.4); facilitating information of the different health and social resources available in patient’s environment to improve their health and wellbeing (item 10, rated 5.72, SD 1.6). Capture of friendliness’ and usefulness’ data is being performed and should be finished in January 2016. Discussion : IEXPAC website is a tool that allows the assessment of Patient experience and from this measure, promoting changes in chronic care approach. The active participation of patients and the integration of all care they receive are objectives of the person-centered care that professionals and organizations strive to achieve. The new evaluative frameworks look for the integration of measures of effectiveness and efficiency together with the experience of patients. This study aims in this direction. Conclusion : The IEXPAC scale facilitates the reorientation towards person-centered care. A useful and user-friendly framework has been designed to introduce the PE measure in several health and social contexts.