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Foreword to the book "When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge"


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We have for some years been witnessing a profound change in our perception of what healthcare should be. Rather than a vision of illness based on episodes requiring a series of interventions of greater or lesser intensity, but which are nonetheless limited in time, we are now very often faced with chronic health problems which accompany sufferers over a number of years. In many cases the same person will suffer from several such chronic diseases simultaneously, making care especially complex, in particular if it is not tackled from an appropriate perspective. We are now beginning to understand that care for people with multiple chronic diseases demands a completely different approach to that which served as the basis for the design of our health systems and traditional working processes.

In Andalusia, a region of Spain located in the far south of Europe, we set out at the start of this decade to introduce substantial improvements in the public healthcare system. The Health Department of the region's government, the Junta de Andalucía, with the extensive involvement of healthcare professionals, planned a number of initiatives structured around an ambitious plan which is still today being deployed. Perhaps the most novel aspect was an attempt to act from the citizen's perspective. By looking through the eyes of the patient, by placing citizens at the heart of the system, we radically altered our vision of the way in which healthcare structures are designed. Continuity of care, coordination among professionals and levels of care, or holistic care, emerged as the major unresolved challenges. Above all, though, we restored a complete vision of the person, each with a whole set of individual health problems. 

This gave new life to the words of William Osler: "it is more important to know what type of person has the disease, than to know what type of disease the person has". When we reconsidered our way of dealing with the most significant health problems, restructuring healthcare operations to make them more appropriate and effective, there emerged the need to define patients with various chronic diseases and to reformulate the way in which every aspect of their complex situation is handled from a healthcare and social perspective. Nursing professionals, specialists in family medicine, internal medicine and other fields of knowledge performed intensive work, using a process re-engineering methodology to define best practice in the handling of such patients, to be applied in a public health system which caters to more than 8 million people. After defining what we refer to as the "polypathological patient", we developed further initiatives to improve care, such as the patients' school, intended to provide chronic disease sufferers with the skills to manage their own conditions, or the multi-channel health platform "informarse es.salud", which provides a number of information and self-help tools.

Along this hugely exciting journey we met health professionals from other regions of the world who shared our concerns and preoccupations, and who were already devising new solutions for complex chronic disease in their own areas. To provide an ongoing basis for contact among experts in complex chronic disease from the five continents, we set up a forum for interaction and shared reflection: OPIMEC. OPIMEC is the Spanish acronym for Spanish acronym for the Observatory of Innovative Practices for Complex Chronic Disease Management. Its aim is to promote the generation of knowledge about this problem and to share innovative experiences worldwide through open, networked cooperation and participation. An increasing number of professionals and experts from different countries now meet up in this virtual forum to exchange experiences and contribute new approaches and concerns.

The gathering staged in Seville in 2009 by the Andalusian School of Public Health and OPIMEC gave rise to the idea of turning this emerging knowledge into a book, to serve as a guide for those who are new to this highly complex issue and make a significant contribution to the consolidation of what is still a new concept, while also identifying best practice approaches based on the soundest scientific evidence available.

It is for me a source of genuine pride to be able to present this book, which has come to fruition in such a short time thanks to the enthusiastic participation and brilliant contributions of 55 experts from 18 countries. I sincerely believe that the text you hold before you summarises the best knowledge yet available about polypathology, its implications for care and administration, possible approaches, embracing health promotion, prevention, self-management and responses covering the entire healthcare itinerary, including supportive and palliative care, along with promising ideas regarding the potential of information and communication technologies, robotics, genomics and nanotechnology. It also contains a valuable chapter on the taxonomy and language of this emerging area, an essential aspect in ensuring that we truly know what we are referring to at each stage.

I am sure that in this helpful and fascinating collective work you will find innovative strategies which could help fill the gap between what we know and what we need to know in order to satisfy the needs and expectations of a growing number of vulnerable people throughout the world.

Representing as it does an open approach to knowledge, in addition to this paper edition you can also access the book on the Internet free of charge in English and Spanish. In order to keep this initiative alive I would warmly invite you to take part in its future editions via www.opimec.org, thereby ensuring that it continues to evolve. Please join us in tackling the huge collective challenge of improving care for people with multiple complex chronic diseases worldwide. With your help, we can do it.

María Jesús Montero Cuadrado

Health Minister,

Andalusian Government




Comments to the whole document


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Ester Estevez Puga
30/04/2014 00:05

Los profesionales debemos de unirnos en esta batalla frente a las enfermedades crónicas y luchar todos juntos y creo que muy interesante que participen profesionales de todo el mundo , ya que, la visión de como afrontarlas , será mucho mas heterogénea.


Maria Lourdes Cabrera Palomo
06/05/2014 09:29

Las enfermedades cronicas son nuestro trabajo diario.

Maria Dolores Muriel Arteaga
06/05/2014 20:46


Trinidad Lechuga Varona
13/05/2014 23:54

Me agrada conocer las experiencias de profesionales nacionales e internacionales.

Pienso que todos podemos aportarnos y en concreto yo espero con entusiasmo, una visión "diferente" en el terreno de la planificación del cuidado y el abordaje farmacológico del paciente crónico.

Maria Jose Puche Garcia
20/05/2014 12:56

Mi mejor aportación a la mejoría de las enfermedades crónicas es de favorecer entornos interdisciplinares, donde el paciente vaya encauzando el acoplamiento de su vida junto con la enfermedad, favoreciendo, sentirse socialmente útiles. Hoy día la definición de salud de la OMS, acoge el bienestar físico, psíquico, social y espiritual. Una vez el físico remonta favorecer el bienestar psíquico, social y espiritual. En Málaga nuestra ciudad, tenemos formado un equipo de voluntariado que acogen esas otras tres premisas, favoreciendo una mejoría de la interacción entre el fármaco y la enfermedad crónica, con muy buenos resultados. Hace poco se hizo un Congreso a nivel de Andalucía, donde los propios pacientes expusieron sus mejorías, en todos los aspectos, e incluso favoreciendo la reducción al mínimo de los fármacos indispensables para su salud. Paciente que usaban 10 y 12 medicamentos, pudieron ir reduciendo según mejoría y prescripción facultativa. Para más información dirigirse a mi correo: mariajosepuchegarcia@yahoo.es

Maria Victoria Martin Yanez
21/05/2014 18:15

Creo que el aforismo “Es más importante conocer que clase de persona tiene la enfermedad, que saber qué clase de enfermedad tiene el paciente” recoge la filosofia que parece encerrar el sentido de este curso.O al menos eso espero


Buenos días.

Los pacientes con enfermedades crónicas son tratados frecuentemente en los servicios de fisioterapia. Como fisioterapeuta estoy muy interesado en los pacientes con enfermedades crónicas.

carmen marin vega
14/09/2016 01:26
La mayoria de personas padece de algun tipo de dolencia, que de manera agravada y continua, se dirige a la enfermedad cronica, estas una vez conseguidas controlar,regular, nos conducirian a una vida sana y plena.
Yolanda Rustarazo Franco
19/09/2016 17:00
Es fundamental que todos los implicados en los cuidados de los pacientes con enfermedades crónicas tomemos conciencia de la necesidad de actualizar nuestros conocimientos y hacer uso de las herramientas que tenemos al alcance, que son muchas.
Compartir experiencias y prácticas profesionales siempre es enriquecedor, aún más desde otras perspectivas y países.
Encarnacion Gonzalez Tapia
21/10/2017 23:52
Abrir nuevos cauces para el conocimiento, la posibilidad de poder compartirlo con otros profesionales resulta muy estimulante. Nos queda avanzar para el adecuado manejo de nuestros pacientes crónicos y sus expectativas de vida futuras.
Francisca Vazquez Romero
09/04/2018 13:52
Las necesidades complejas de pacientes crónicos tiene un dificil abordaje y me parece importante estar al dia en las últimas innovaciones al respecto.
Manuel Aires López
11/09/2018 12:28
Es un trabajo ilusionante que puede ayudarnos a enfrentar cada dìa a la complejidad que va adquiriendo la atención y cuidado de los pacientes crónicos, muchos de ellos frágiles. Tener a tu alcance de manera inmediata estrategias innovadoras de abordaje e incluso poder participar es ellas, te genera seguridad y motivación.
La literatura sobre la atención y cuidado de los pacientes crónicos, pluripatologicos está perfectamente definida ahora nos falta garra,empuje y medios para llevarla acabo.