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…

Evaluation of the home help service and its impact on the informal caregiver's burden of dependent elders

Aim This study looks at the objective and subjective characteristics of home respite service provision and its impact on the informal care burden of dependent elders. Method A sample of 296 dependent people and their informal caregivers was randomly selected among users and non-users of the Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). An experimental design was used and a field study was carrying out that collected information on sociodemographic variables of the dependent person and his/her caregiver, HHS characteristics and the assessment of the services delivered by this resource as well as the informal caregivers'burden. Results The results show that t…

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 …

Variables related to the informal caregivers' burden of dependent senior citizens in Spain

The study aims at analyzing the psychosocial variables associated with the informal caregivers" burden of dependent older people. A sample of 296 dependent people and their informal caregivers (n= 153) was randomly selected among users and non-users of the Spanish public In-Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). Diverse variables in reference to the care context and the caregiver as well as the care recipient show major associations with the burden: those associated to disease and the social situation of the dependent person, the greater frequency and intensity of care, and the low frequency in which the caregiver receives help from others. The obtai…

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.

Perspectivas actuales en Psicología de la Religión

El objetivo del trabajo radica en llevar a cabo una revision sobre el estado actual de las investigaciones rejerentes a los aspectos psicosociales de la religion.Se comienza planteando los problema...

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.

Integrated Care in Europe

Development and Validation of a Self-Administered Multidimensional Prognostic Index to Predict Negative Health Outcomes in Community-Dwelling Persons

The multidimensional prognostic index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that accurately predicts negative health outcomes in older subjects with different diseases and settings. To calculate the MPI several validated tools are assessed by health care professionals according to the CGA, whereas self-reported information by the patients is not available, but it could be of importance for the early identification of frailty. We aimed to develop and validate a self-administered MPI (SELFY-MPI) in community-dwelling subjects. For this reason, we enrolled 167 subjects (mean age = 67.3, range = 20-88 years, 51% = men). All subjects underwent a CGA-based assessment to c…

Care needs among the dependent population in Spain: an empirical approach.

The objective of the present paper was to identify the profile and needs of social and healthcare users in Spain who required long-term care. To achieve this goal, an extensive empirical study was carried out in 2001 of a typical southern European region: the Valencia Autonomous Region in Spain. The method used was a questionnaire-based survey. The data collection instrument was a questionnaire comprising 119 questions grouped into seven sections: social and demographic data; clinical diagnosis and treatment; living environment; degree of dependence in activities of daily living (ADLs); cognitive state; social support; and the social, demographic and attendance data of the carer, if availab…

Squaring the welfare circle and government ideology: Greece and Spain in the 1990s

This article examines the “squaring the welfare circle” thesis and its usefulness to our understanding of welfare developments in Greece and Spain in the 1990s. The welfare state in both Greece and Spain was expanded considerably in the early 1980s by the newly elected socialist governments, only to hit the buffers of diminishing resources and rising demands in the late 1980s as well as the hostile neo-liberal welfare ideology. The process of welfare expansion was halted in the 1990s, labour market deregulation was encouraged and containment of welfare expenditure became the dominant aim of government policies. This article concentrates on the actual policies of governments in the 1990s rat…

Observations on the Progress of Welfare-State Construction in Hungary, Poland, and the Czech Republic

Three specialists in social services present an assessment of Hungary's performance during the economic transition from the perspective of social policy and the general welfare of the population. Using figures drawn from a variety of European sources, they offer a review of social expenditure, labor market tendencies, and the social security, health and education systems, comparing throughout with data from the Czech Republic, Poland and the European Union.

Accesible co-creation tools for people with intellectual disabilities: working for and with end-users

In a world defined by rapid change, the search for solutions to societal challenges has become more complex calling for new paradigms of innovation focused on collaborations with the community and users. Co-creation approaches in the design and production of a service or product can bring low-cost innovation and unique and personalized customer experiences leading to user acceptance of a product or service. Under a co-creation perspective, the participatory approach developed in the MINDInclusion project aims to improve the inclusion of people with intellectual disabilities into public places and society by using a co-created online tool based on people with disabilities’ personal experienc…

The care of the informal caregiver's burden by the Spanish public system of social welfare: a review.

Abstract This work analyzes the public social services system developed in Spain to attend dependent persons and their informal caregivers, examining in a more detailed way the current capacity of the Spanish public In-Home Help Service (HHS) to meet the demands of dependent elderly persons and its impact on their informal caregiver's burden. We begin with a brief introduction of the services by the Spanish public social services system developed to attend dependency; next, the evolution of the Spanish public HHS is described in a thorough way to identify the pros and cons of this service regarding the informal caregivers’ burden of dependent elders. Finally, recommendations are proposed to…

The informal caregiver's burden of dependent people: Theory and empirical review.

This paper reviews the main theories and results of the existing research to date about the concept of the informal caregiver's burden. The explanation of the burden concept, the theoretical approaches which attempt to explain it, the variables which have emerged in the investigation, the predictors of its appearance, as well as the intervention programs developed to relieve burden, allow us to approach the appropriate solutions to deal with the current social and political reality of this problem. In this sense, the psycho-educational intervention programs framed within the respite services jointly with the knowledge of the determining variables of the burden can comprise the first optimal…

Design of an ICT Tool for Decision Making in Social and Health Policies

The governance requires technical support regarding the complexity in deciding health policies to assist people who require long-term care. Long-term care policies require the use of ICT simulation tools that can provide policy makers with the option of going into a decision theatre and virtually knowing the consequences of different policies prior to finally determining the real policy to be adopted. In this sense, there is an absence of simulation tools for decision making about long-term care policies. In this chapter, the authors propose the foundations and guidelines of SSIMSOWELL, a new scalable, multiagent simulation tool that increases the prediction capacity of governance in the lo…

Towards a new welfare state: the social sustainability principle and health care strategies.

In this paper we propose a social and health care model that offers alternatives to three problems arising in converging European welfare states, particularly in the southern nations: the rise in demand for services and features linked to the ageing process, the increase in dependency and the crisis of informal support. Development of the principles of social sustainability implies re-formulation of the regulatory, care, economic, administrative, cultural, and axiological framework enabling a response to the needs of long term care without compromising the welfare of future generations. Together with this principle, quality of life elevated to a subjective right directs attention towards th…

La gestión de casos como metodología para la conexión de los sistemas sanitario y social en España

ResumenObjetivoEl objetivo de este artículo es presentar la evaluación de un proyecto de gestión de casos con pacientes crónicos en Valencia para la integración de la atención social y sanitaria. Este proyecto está vinculado con el «Modelo sociosanitario sostenible».EmplazamientoDepartamento de Salud 6, Comunidad Valenciana.ParticipantesPacientes con patologías crónicas de 65 o más años.IntervencionesEstudio comparativo con un grupo control y otro de intervención, no aleatorizado ni ciego. La intervención consistió en la creación de un equipo interdisciplinar de gestión de casos, el uso de una cartera común de recursos y su aplicación a una muestra piloto. Duración de la intervención: 6-9 m…

Improving the management of potentially predictable hospital readmissions of the elderly and their quality of life through new icts

3rd International Conference on the Elderly and New Technologies. III Jornadas Internacionales de Mayores y Nuevas Tecnologías. The ageing population is currently beginning to create economic repercussions, as ageing often implies an increase of health expenditure related to, specially, hospital admissions and/or unplanned readmissions and long term care services. The present paper deals with two strategies that could be implemented through the establishment and use of new technologies to avoid these increasing costs: 1) screening tools of health information systems aimed at identifying patients at risk of hospital readmissions or repeated use of health resources; and 2) new icts at elderly…

A review of programs to alleviate the burden of informal caregivers of dependent persons.

The review of interventions currently available to alleviate the burden of informal caregivers of dependent persons has both social and political relevance considering the increasing number of elderly dependent persons. Respite services and programs for psycho-social intervention are the main methods of dealing with this burden. Study of the main research carried out to date on such interventions enables us to organize more efficient services, especially considering the enactment of the Law on Dependence in Spain in January 2007 and the need for other European and international governments to establish systems to meet the needs of the growing dependent population.

Suitability of the health and social care resources for persons requiring long-term care in Spain: An empirical approach

Abstract The objective of this paper is to examine the suitability of specific facilities for dependent persons for meeting users’ needs. A total of 1265 users of social and health facilities for dependent persons were interviewed in a study carried out in a typical southern European region with a Mediterranean welfare system: the Valencia Autonomous Region in Spain. Data were obtained on users’ socio-demographic profile, health, functional dependence, cognition, social support and housing suitability. Based on these data and the institutional definitions of the specific facilities for dependent persons, the suitability index was drawn up for each facility and suitability was evaluated usin…

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…

Towards a Simulator of Integrated Long-Term Care Systems for Elderly People

In this paper, we propose a simulator for integrated long-term care systems using as a starting point a holistic model of care systems for people that need long term care, the Sustainable Socio-Health Model (SSHM). The implementation of the simulator on the Jason multi-agent platform allows the tool to include the human interactions, preferences, and social abilities that take place between elderly people and the staff of healthcare systems (doctors, social workers and nurses). In addition, the use of this multi-agent platform provides the required scalability for simulating population sizes of different orders of magnitude. The paper shows the model to be implemented in the simulator, the…

La teoría del apoyo social y sus implicaciones para el ajuste psicosocial de los enfermos oncológicos

Desde una perspectiva funcionalista los humanos, en su infancia, pronto des-cubren que deben aprender a ser efectivos con la avalancha estimular de su me-dio concreto; al mover sus miembros se dan cuenta de que pueden hacerlo ysiguen repitiendo los movimientos cual reminiscencia, segun diria Allport (1924),del reflejo circular. Desde este preciso instante podria estar ya haciendo posola futura auto-estima del individuo adulto, retomando la corriente de WilliamJames, para quien la autoestima era una funcion de los exitos que pretendemoso a los que aspiramos.Posteriormente, esa necesidad de efectividad y competencia con el medioambiente —para una distincion de ambos terminos vease White (1959…