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Andalusia, Care path for the management of patients living with multiple chronic conditions

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by Administrador OPIMEC
2 Sep 2008

Hospital Universitario Virgen del Rocío

Andalusia Process of care for patient care multipathological is the set of activities aimed at ensuring patients multipathological an integral health care, coordinating the professionals, services or facilities, with time and under the current Public Health System Andalusia. This process includes: 1) Identification. 2) Poll comprehensive. 3) Continued Assistance Plan (PACEI), as a model of joint assistance between AP and AE, which provides the continuity of patient care multipathological. 4) hospital care. 5) Focus on the person. In this plan an important pillar is the people work together with caregivers through the early identification of their needs and assisting in performing their role. This has led to the development of the plan of care also led to the person and their family caregivers.

Fragility, pluripathology and/or complex chronic diseases

Goals Prevention:
Creates healthy environments
Goals Detection:
Provides registries and patients contact systems
Goals Treatment:
It facilitates the management by processes
Goals self-management:
Allows home care

pluri.pdf
pluri_ingles.pdf

2/09/2008

SPAIN

Andalucía

Sevilla

Sevilla

Avenida de la Innovación s/n Edif. Arena 1.

portalsalud.csalud@juntadeandalucia.es
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