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