Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program
Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multid...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.1033689/full |
| _version_ | 1811209960791474176 |
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| author | Miguel García-Hernández Miguel García-Hernández Beatriz González de León Beatriz González de León Silvia Barreto-Cruz Silvia Barreto-Cruz José Ramón Vázquez-Díaz José Ramón Vázquez-Díaz |
| author_facet | Miguel García-Hernández Miguel García-Hernández Beatriz González de León Beatriz González de León Silvia Barreto-Cruz Silvia Barreto-Cruz José Ramón Vázquez-Díaz José Ramón Vázquez-Díaz |
| author_sort | Miguel García-Hernández |
| collection | DOAJ |
| description | Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program. |
| first_indexed | 2024-04-12T04:48:58Z |
| format | Article |
| id | doaj.art-762676c9f2b64e58847b914745e05cba |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-12T04:48:58Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-762676c9f2b64e58847b914745e05cba2022-12-22T03:47:23ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-11-01910.3389/fmed.2022.10336891033689Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA programMiguel García-Hernández0Miguel García-Hernández1Beatriz González de León2Beatriz González de León3Silvia Barreto-Cruz4Silvia Barreto-Cruz5José Ramón Vázquez-Díaz6José Ramón Vázquez-Díaz7Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, SpainNetwork for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, SpainUnidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, SpainNetwork for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, SpainUnidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, SpainNetwork for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, SpainUnidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, SpainNetwork for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, SpainMultimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.https://www.frontiersin.org/articles/10.3389/fmed.2022.1033689/fullfamily practicemultimorbidityinternship and residencypatient care managementpatient-centered carepatient discharge |
| spellingShingle | Miguel García-Hernández Miguel García-Hernández Beatriz González de León Beatriz González de León Silvia Barreto-Cruz Silvia Barreto-Cruz José Ramón Vázquez-Díaz José Ramón Vázquez-Díaz Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program Frontiers in Medicine family practice multimorbidity internship and residency patient care management patient-centered care patient discharge |
| title | Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program |
| title_full | Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program |
| title_fullStr | Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program |
| title_full_unstemmed | Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program |
| title_short | Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program |
| title_sort | multicomponent high intensity and patient centered care intervention for complex patients in transitional care spica program |
| topic | family practice multimorbidity internship and residency patient care management patient-centered care patient discharge |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.1033689/full |
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