Original Title: La gestión del paciente mayor con patología crónica

Authors' objectives: This survey sets out to describe the current management of elderly patients with chronic pathologies in our community and to propose alternatives to the current use of services for overall quality care, based on experiences in our environment.

Authors' results and conclusions: This study confirms that elderly patients with controlled chronic pathology, low physical/psychic dependence and good family and social support, are adequately looked after in their own homes. The risk of a worsening in the state of health of these patients has led to an increase in medical admissions in short-term hospitals of 46% over the last decade. Nevertheless, within short-term hospital admissions, a high proportion of inappropriate admissions (17.6%) have been identified, due to the fact that diagnostic and/or therapeutic tests are carried out while the patients are in hospital, in spite of the fact that these do not require hospitalisation (60%). Referrals to medium-term hospitals and the socialhealthcare system have also increased (49% during the period 2004-2006), highlighting the need for intermediate levels of care. At the same time, social problems due to medium-term admissions have decreased. Among the alternatives assessed for the management of patients with chronic pathologies, the Chronic Pathology Care Model has been applied to the EPOC, in accordance with the characteristics of our health system.

Authors' recommendations: Primary Healthcare must form the backbone to the care of elderly patients with chronic pathologies, but it is necessary to redefine the handling and control of chronic diseases, as well as the functions of professionals working at each level of care. Doctors, nurses, patients and their carers, if any, form a care team that must operate proactively, by making patients aware of their condition and encouraging them to care for themselves. Management of chronic processes must be based on early detection, on the overall assessment of patients, as well as the search for more efficient treatments at different levels of care. Moreover, programmed hospital admissions must be promoted both in short-term hospitals and at intermediate levels (medium-term hospitals and social-health services). Experiments such as those conducted in Gipuzkoa should be promoted in order to adapt to and implement those aspects of proven efficiency in each model in the handling of chronic illnesses in order to offer patients the most adequate care level in accordance with their means.

Authors' methods: Different groups within the elderly population with chronic pathologies are identified in accordance with their use of available health services resources (MBDSs; ESTADIS, DRGs). An assessment is made of the appropriate balance between requirements and the resources used: Short-term hospitals; mediumterm hospitals, social-health and primary care resource, through a questionnaire sent to medium-term patients and the social-healthcare system. A review is made of the most relevant publications in this area over recent years and the basic considerations to be borne in mind in the care of elderly people, their situation in the health system in accordance with their means, and the level of attention on which patients care must be articulated at every moment during the treatment of their pathologies have been drawn up. A panel of experts have met in three sessions to discuss the strengths and weaknesses of the current care system for elderly people and the possible alternatives. Finally, the panel has applied the proposed care guidelines to a highly prevalent disease among this age group: Chronic Obstructive Pulmonary Disease (COPD).

Project Status: Completed

Year Published: 2008

URL for published report: https://www.euskadi.eus/contenidos/informacion/2008_osteba_publicacion/es_def/adjuntos/D_08_05%20paciente%20mayor.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>