Comments of Management models

What do we need to know?

 

Although there is growing evidence of the effectiveness and efficiency of interventions related to chronic care management (7, 11, 14, 65-72) (Table 2), there is little specifically related to the impact of care models for the management of different combinations of complex diseases.

Some disappointing results from the application of the Evercare model in the British NHS, along with somewhat promising new evidence in support of case management of vulnerable elderly people (70, 74-76) underscore the need for further efforts to understand the role of care models for the management of multiple chronic diseases (77). Such efforts should focus on:

- The applicability and impact of different models in diverse contexts.

- The development of a consistent language for the different elements in the models.

- Standardization of interventions.

- Comparative evaluation of the  benefits of multiple vs. isolated interventions.

- Implementation strategies to facilitate rapid and successful implementation and dissemination.

- Their economic impact and efficiency.

 

Table 2. Effective interventions in the management of chronic patients (produced by the authors) (7, 11, 14, 65-72)

  • Integrated disease management models and programs (of the CCM type)
  • Disease management programs for specific conditions: diabetes, heart failure, etc.
  • Service coordination and integration initiatives
  • Strengthening of primary care
  • Support and promotion of self-management
  • Geriatric evaluation
  • Identification of groups at higher risk of hospitalization
  • Early discharge programs for specific illnesses
  • Expansion of nursing roles
  • Remote monitoring
  • Multidisciplinary interventions

Existing comments

28/06/2012 María Lopez Cano
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La experiencia refleja que para conseguir una continuidad asistencial es imprescindible la coordinacion de los servicios sanitarios y sociales y se tienen que establecer intervenciones dirigidas a conseguir esta coordinacion. 

Otra intervencion a tener en cuenta en la atencion al paciente cronico, es no olvidar el pilar fundamental que supone en la atencion a estos pacientes , el cuidador principal o informal. A la hora de intervenir tener en cuenta el binomio paciente-cuidador

21/03/2012 Isabel Sampedro
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Sorprenden los resultados en Inglaterra del modelo Evercare, aunque finalmente parece que cualitativamente merece la pena seguir el modelo y lo han hecho. ¿Se ha intentado en alguna de las Comunidades autónomas españolas? Interesante tabla de intervenciones para diseño de trabajos locales

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para el éxito del modelo de gestion de casos complejos, hay que  dotar al médico y a la enfemera de primaria, de las herramientas, conocimientos y formacion necesarios para afrontar la respuesta desde este nuevo enfoque.

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