Desarrollo e implementación de la Estrategia de Cronicidad del País Vasco: lecciones aprendidas

ResumenLa sanidad pública de Euskadi afronta unas altas tasas de envejecimiento y cronicidad, que tensionan la sostenibilidad del sistema. En respuesta a esta situación, en 2010 se puso en marcha la Estrategia Vasca de Cronicidad como una iniciativa de transformación de amplia escala y largo alcance centrada en un cambio del modelo de provisión sanitaria hacia la atención integrada a la cronicidad. Desarrollada en un contexto caracterizado por la crisis económico-financiera, la fuerte oposición política, y la resistencia o la pasividad de grupos de interés relevantes, el diseño y la implementación de la Estrategia aportó algunos elementos destacables, como son una narrativa de cambio diferente a la de austeridad, que era la dominante en ese momento; un enfoque estratégico sustentado en una base de evidencia y en referentes teóricos contrastados; y un planteamiento de implementación que propiciaba la innovación local y de «abajo arriba». Pese a ello, no se consiguió superar plenamente las barreras de la debilidad política y de la inmovilidad burocrática, las cuales limitaron el despliegue y el alcance de los cambios, sobre todo los relativos a la escalabilidad de las innovaciones locales de éxito. En cualquier caso, como fruto de la Estrategia son apreciables algunos cambios en la cultura de integración asistencial, tanto en el ámbito clínico como en el gestor, así como la progresión organizativa dentro de un modelo de atención orientado a la cronicidad.AbstractPublic healthcare in the Basque Country (Spain) faces high rates of ageing and chronicity, which stress the sustainability of the system. In response to this situation, the Basque Chronicity Strategy was launched in 2010. This large-scale and far-reaching transformation initiative focused on changing the healthcare provision model towards integrated care of chronicity. Developed in the context of economic and financial crisis, strong political opposition and resistance or passivity of many relevant stakeholders, the design and implementation of the Strategy introduced some noteworthy elements, such as: a narrative of change different to the austerity discourse, which was the dominant narrative at that time; a strategic approach supported by an evidence base and solid theoretical references; and an implementation strategy that favoured local innovation and the “bottom up” approach. In spite of this, it was not possible to overcome the political barriers or bureaucratic immobility, which limited the implementation and scope of the changes, especially those related to the scalability of successful local innovations. However, some changes in the healthcare integration culture at clinical and managerial level have been introduced as a result of the Strategy, as well as organisational progression towards a chronicity-targeted healthcare model

Are Healthcare Organizations Ready for Change? Comment on “Development and Content Validation of a Transcultural Instrument to Assess Organizational Readiness for Knowledge Translation in Healthcare Organizations: The OR4KT”

Worldwide most health systems are facing a series of common challenges characterized by the increasing burden of chronic diseases and multimorbidity, and the accelerated pace of biomedical and technological innovations, on the other side. There is a growing recognition that many changes are needed at the macro, meso and micro management levels to tackle these challenges. Therefore, knowing if healthcare organizations are ready for change is a key issue, as high organizational readiness for change (ORC) has been positively related with higher organizational effort and staff motivation for overcoming barriers and setbacks in change endeavours. In practice, readiness for change is not commonly measured and there is a need of adequate metrics for it. In this commentary, a new tool for measuring readiness change is reviewed, the OR4KT. It has been developed based on a solid theoretical background and with the involvement of experts and potential users in the design and it has been tested and validated in three languages and in different organizational settings. Although its generalizability needs to be further tested, it seems to be a promising and useful tool to diagnose if organizations are ready to implement evidence-informed changes. A broader recognition of the key role that the science of implementation can play in the success of much needed transformations in healthcare provides a good opportunity for the dissemination of the OR4KT

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

Background: Mental illness, multi-morbidity, and socio-economic inequalities are some of the main challenges for the public health system nowadays, and are further aggravated by the process of population aging. Therefore, it is widely accepted that health systems need to focus their strategies for confronting such concerns. With guaranteed access to health care services under universal coverage in many health systems, it is expected that all services be provided equally to patients with the same level of need. Methods: In this paper, we explore the existence of inequalities in the access to services of patients with mental illness taking into account whether they are multimorbid patients, their socioeconomic status, and their age (...

Is utilization of health services for HIV patients equal by socioeconomic status? Evidence from the Basque country

Access to ART and health services is guaranteed under universal coverage to improve life expectancy and quality of life for HIV patients. However, it remains unknown whether patients of different socioeconomic background equally use different types of health services

Влияние солей тяжелых металлов на активность ферментов глиоксилатного цикла и митохондриальной сукцинатдегидрогеназы в прорастающих семенах сои

Исследовано влияние СоСl2 и СdСl2 на активность изоцитратлиазы, малатсинтазы и сукцинатдегидрогеназы в семядолях сои на ранних этапах прорастания. Показано, что СоСl2 активирует изоцитратлиазную активность на третьи сутки, а СdСl2 ингибирует активность этого фермента уже в первые сутки прорастания по сравнению с контролем. Активность малатсинтазы снижается на пятые сутки прорастания независимо от наличия солей металлов. Ионы металлов тормозят активность сукцинатдегидрогеназы к пятым суткам.The influence of CoCl2 and CdCl2 on the activity of isocitratlyase, malatsynthase and succinate dehydrogenase in the seedlobes at early stages of germination of soybean seeds was investigated. CoCl2 increased isocitratlyase activity at 3-d day and CdCl2 suppressed isocitratlyase activity at the 1-st day. Salt of metals has no influence on malatsynthase activity. CoCl2 and CdCl2 suppressed succinate dehydrogenase activity at 5-th day that may be caused by oxidative stress

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Pathways towards chronic-care focused healthcare systems: evidence from SpainPathways towards chronic-care focused healthcare systems: evidence from Spai

Community Based Participatory Research For The Development of a Compassionate Community: The Case of Getxo Zurekin

[EN] Introduction: In the face of a growing ageing population and rising care needs, compassionate communities seek to visualize the community as an equal partner in the complex task of providing quality social and health care at the end of life. Description: Getxo Zurekin is a social innovation example for the creation of a compassionate community in Getxo, one of the most populated cities in the province of Biscay, with 25.46% of its population aged over 65. Mixed methodologies have been applied, active listening and co-creation of actions and strategies towards improving care and quality of life for people and families facing advanced disease and end of life situations, with more than 80 people interviewed to conform the basis for a collective sense making. The initiative has reached more than 1,000 people in Getxo. Discussion: Following a systemic approach, horizontal relationships and cross-sectoral collaborations have allowed engaging the active involvement of local agents in the collective sense making and co- creation process. Conclusion: Getxo Zurekin represents an example of a participatory action research model, which has shown to be effective to meet initial targets towards creation of a compassionate community

HIV in Spain 2017: policies for a new management of chronicity beyond virological control

The analysis of the available databases related to HIV/AIDS confirms a paradigm shift in the patient's life expectancy: now HIV has become a chronic disease, so patients are aging. However, this advance is accompanied by a negative counterpart: due to the increase in the number of years of life gained, there is a prevalence of comorbidities greater than the general population and at an earlier age. Reducing the risk associated with all the comorbidities that the ageing patient with HIV/AIDS may develop, must now be a health objective; it must be added to the traditional objectives that until now were part of the strategy to reduce the impact of the HIV infection. In the specific case of women, it is also necessary to train peri and postmenopausal women to increase their skills and motivation to care for their health; It is also very important to examine the role that hormone replacement therapy can play in reducing their symptoms.El análisis de las bases de datos disponibles relacionadas con VIH/SIDA confirma un cambio de paradigma en la esperanza de vida del pa-ciente: ahora el VIH se ha convertido en una enfermedad crónica, con la que los pacientes están envejeciendo. No obstante, este avance se acompaña de una contraparte negativa: debido al incremento en el número de años de vida ganados, se da una prevalencia de comorbilidades mayor a la de la población general y a una edad más temprana. Reducir el riesgo asociado a todas las comorbilidades que puede desarrollar el paciente con VIH/SIDA mientras envejece debe ser hoy en día un objetivo de salud, que se suma a los objetivos tradicionales que hasta ahora formaban parte de la estrategia para reducir el impacto de la infección por el VIH. En el caso específico de la mujer, además es necesario formar a las mujeres peri y postmenopáusi-cas para incrementar sus habilidades y su motivación para el cuidado de su salud; también es muy importante que se examine el rol que puede tener la terapia de reemplazo hormonal en la reducción de sus síntomas. Palabras clave: VIH, SIDA, Comorbilidad, Cronicidad, Envejeci-miento, Política sanitaria, Gestión clínicaEl presente trabajo ha sido editado por la Fundación Gaspar Casal, con ayuda del patrocinio de Gilead Sciences.S