0000000000006449
AUTHOR
Ascensión Doñate-martínez
Planning integrated care at primary care centres: lessons learnt through research in stratification tools in the Valencian Healthcare System
Introduction and policy context: In the Valencian Region social services and the healthcare system are not connected. Also there is not any normative jointly regulating resources, services or aid benefits that would mean an integrated care IC portfolio. Primary care PC centres are the closest and most trustworthy care facility for patients in the Spanish context. Also, PC is one of the most suitable resources to address needs of complex patients, as elderly and/or those with chronic conditions, through an IC approach, but there are some barriers that block its real and effective deployment. Objective and target population: Authors have studied the viability, implementation and development …
Palliative care and complex chronic conditions since the perspective of healthcare professionals
Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). R…
Implementation of a self-management programme: recruitment strategies in five European countries
Abstract Introduction The Chronic Disease Self-Management Programme (CDSMP) has been successfully implemented in over 30 countries worldwide, demonstrating its effectiveness and cost savings to healthcare systems. The CDSMP aims at people with any chronic condition and caregivers, but it has not targeted specific vulnerable populations at different sites simultaneously. In this sense, this study presents the recruitment strategies to involve vulnerable populations in the CDSMP framed under the EU-funded project EFFICHRONIC (ref.: 738127). Methods The CDSMP was implemented in five countries (Spain, Italy, France, the Netherlands and the United Kinkdom) approaching several vulnerable target g…
Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)
Abstract Background Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. Methods The sample ( n = 74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme …
Patients with non-oncological chronic conditions: Improving end-of-life care through integrated care and early palliative care provision
Background: The last WHO definition of palliative care (PC) recognizes the integration of early PC in the course of illness and in conjunction with other therapies that are intended to treat disease as the way to provide optimal care. There is wide literature highlighting the benefits of early implementation of PC in oncological patients and there is a growing recognition of PC as an integral aspect of cancer treatment with the establishment of a range of specific guidelines concerning palliative cancer care. Nevertheless, these advances are not developed to the same extent in the approach of non-oncological chronic conditions. In this regard, patients of non-cancer diseases are rarely offe…
Education and Training for Parents Today, Discipline and Wellbeing for Children Tomorrow
Abstract Children's upbringing is one of the most important and difficult roles and challenges for parents today. This paper presents a new model of parenting training developed within the project “BE Supportive, NOT violent! Positive parenting for happy children!”- III Daphne Programme (European Commission). Parents from several countries – among them Spain – were trained receiving informative background as well as practical advice for everyday use. The main results show that parents acquired useful techniques for upbringing children as communication skills or strategies to set limits, and moreover they got to know more about children's development. In this sense, providing basic knowledge…
A New Educational Model to Train Parents for a Successful Upbringing of Children: A European Cross-national Study
Abstract The quality of parenting skills is fundamental to the children's well-being. The project “BE Supportive, NOT violent! Positive parenting for happy children!”, funded by the European Commission, proposes a new model of positive parenting to provide and reinforce parents’ knowledge, resources and tools to achieve a positive relationship and communication with their children. The model has been implemented twice with parents from Romania, Spain, Latvia, Poland, Italy and Sweden with positive results.
Adaptation and Refinement of Validated Risk Screening Tools in the Spanish Healthcare System
Abstract The aim of this study is to develop a tool to screen elders at risk of hospital readmissions adapted to Spanish target population. The development of this new tool is based on the validated instrument The Community Assessment Risk Screen – CARS –, which is being applied in a sample of 1.000 older patients. The adaptation and refinement of CARS is being carried out through the compilation of new potential variables from primary care clinicians to predict patients at risk of readmissions. The introduction of this new instrument adapted to Spanish target population will provide a potential tool to identify prematurel y patients at risk of hospital readmissions.
Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain).
Abstract The Sustainable Social and Healthcare Model (SSHM) is aimed to establish new care pathways in primary care systems contributing to the decrease of health services use and costs and improve the integration and efficiency of social and health care for elderly people with long-term care (LTC) needs. One of these strategies is the segmentation of population in risk groups through standardized tools. This paper is a retrospective study aimed to determine the viability of the implementation of the screening tools Probability of Repeated Admission – Pra – and The Community Assessment Risk Screen – CARS – to detect patients at risk of hospital readmission in a sample of 500 elderly people …
Complementary frailty and mortality prediction models on older patients as a tool for assessing palliative care needs.
Background: Palliative care (PC) has demonstrated benefits for life-limiting illnesses. Cancer patients have mainly accessed these services, but there is growing consensus about the importance of promoting access for patients with non-malignant disease. Bad survival prognosis and patient9s frailty are usual dimensions to decide PC inclusion. Objectives: The main aim of this work is to design and evaluate three quantitative models based on machine learning approaches to predict frailty and mortality on older patients in the context of supporting palliative care decision making: one-year mortality, survival regression and one-year frailty classification. Methods: The dataset used in this stud…
Responsive and Minimalist App Based on Explainable AI to Assess Palliative Care Needs during Bedside Consultations on Older Patients
[EN] Palliative care is an alternative to standard care for gravely ill patients that has demonstrated many clinical benefits in cost-effective interventions. It is expected to grow in demand soon, so it is necessary to detect those patients who may benefit from these programs using a personalised objective criterion at the correct time. Our goal was to develop a responsive and minimalist web application embedding a 1-year mortality explainable predictive model to assess palliative care at bedside consultation. A 1-year mortality predictive model has been trained. We ranked the input variables and evaluated models with an increasing number of variables. We selected the model with the seven …
The Experiences and Views on Palliative Care of Older People with Multimorbidities, Their Family Caregivers and Professionals in a Spanish Hospital
The increasing prevalence of complex chronic diseases in the population over 65 years of age is causing a major impact on health systems. This study aims to explore the needs and preferences of the multimorbid patient and carers to improve the palliative care received. The perspective of professionals who work with this profile of patients was also taken into account. A qualitative study was conducted using semi-structured interviews with open-ended questions. Separate topic guides were developed for patients, careers and health professionals. We included 12 patients, 11 caregivers and 16 health professionals in Spain. The results showed multiple unmet needs of patients and families/caregiv…
Exploring the application of the navigation model with people experiencing homelessness: a scoping review
People experiencing homelessness are known to be at risk of disproportionately poor health outcomes and often face barriers in accessing healthcare. Patient navigation (PN) has been identified as a way to address health disparities and engage underserved populations with healthcare services . This scoping review aims to understand how PN models have been utilized with people experiencing homelessness and other comparable populations to date and more specifically identify (a) the defining features, (b) the barriers and facilitators in implementation, and (c) the outcomes associated with PN models. Database searches were conducted in Web of Science, PubMed and SCOPUS on 15th June 2021 and 21 …
Risk stratification at primary care centres in Valencia (Spain) to activate integrated care pathways for elderly patients with chronic conditions
Introduction: The activation of integrated care pathways is not always easy and is time-consuming, so the standardized use of stratification tools (ST) can support health care professionals in decision-making processes. Several ST –developed and validated in the United States– have been implemented in the Valencia Region (Spain) at primary care (PC) centres to identify elders with multimorbidity at risk of suffering future hospital admissions (FHA). In spite of the usefulness of these instruments, it would be recommended to apply STs which have been specifically designed on the basis of the Spanish healthcare system and the characteristics of its population. Thus, the objective of this stud…
Aplicación de The Community Assessment Risk Screen en centros de atención primaria del Sistema Sanitario Valenciano
ResumenObjetivoAplicar la herramienta The Community Assessment Risk Screen (CARS) para detectar pacientes mayores con riesgo de reingreso hospitalario y estudiar la viabilidad de su inclusión en los sistemas de información sanitaria.DiseñoEstudio de cohortes retrospectivo.EmplazamientoDepartamentos de salud 6, 10 y 11 de la Comunidad Valenciana.ParticipantesPacientes de 65años o más atendidos en diciembre de 2008 en 6 centros de salud. La muestra fue de 500 pacientes (error muestral=±4,37%, fracción de muestreo=1/307).MedicionesInstrumento CARS formado por 3ítems: diagnósticos (enfermedades cardiacas, diabetes, infarto de miocardio, ictus, EPOC, cáncer), número de fármacos prescritos e ingr…
Co-created training program to promote active ageing in people with Down syndrome
Abstract Background Population ageing is a current challenge for the European society. Specifically, People with Down Syndrome (PDS) are living longer than before, reaching some of them around 60 years old. However, it is known that they show premature ageing that in some cases may be misled with Alzheimer first signs. Hence, it is crucial to promote an Active Ageing (AA) and healthy living in this specific population by keeping their cognitive, physical and emotional functions, and also promoting social activities such as community participation. In such way, their Quality of Life (QoL) will be increased. Objectives The main objective of this study was to co-design a Training Program (TP) …
Palliative Care Needs and Integration of Palliative Care Support in COPD
Background The provision of palliative care for severe COPD remains low, resulting in unmet needs in patients and carers. Research Questions What are the palliative care needs of patients living with severe COPD and their caregivers? What views of accessing and providing palliative care and factors influence these experiences. To what extent have palliative care and COPD services been integrated? Study Design and Methods A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the United Kingdom involving patients with severe COPD, their carers, and health professionals. Data were collected using semistructured interviews and were analyzed using fram…
Digital and innovation skills in health care professionals in Europe
Abstract Background Rising life expectancy and ageing population are current phenomena that European society is facing and these are challenges for the European healthcare systems. To face them, several e-health solutions are already designed to optimize resources of the healthcare provider system. However, most of them are not being implemented or deployed. Some of the reasons are the lack of digital skills and innovation readiness in staff, and existing barriers to changing organizational practices. Objectives The DISH project (601008-EPP-1-2018-1-DK-EPPKA2-SSA) will develop 3 concepts to improve the digitalization of healthcare staff to help them in the use of e-health solutions already …