The Pluripathology Patients and Integrated Healthcare Unit, is a collaborative project between five researchers experts in the area and fourteen teams of primary healthcare. Members of the collaborative group share opinions and jointly monitor the progress of patients with multiple chronic conditions by sharing information via the Internet, of Telephone.
This system of collaboration facilitates the resolutions of doubts and enables professions to reach informed decisions faster than normal circumstances.
Fragility, pluripathology/polipathology and/or complex chronic diseases, All
Goals Prevention:
Funding for detection programs , Creates healthy environments
Goals Detection:
Promotes early intervention through primary health care measures , Provides registries and patients contact systems , Shows new evidence on the importance of early detection, including guidelines of effective practices , Advances public education on the importance of early detection
Goals Treatment:
Promotes the appropriate use of medicines , Promotes the training of health professionals , It facilitates the management by processes , Emphasizes the care of pluri-pathological and fragile patients , Promotes electronic health information systems to improve the quality of care
Goals self-management:
Allows home care , Allows remote support to patients and their carers from health professionals