Search

A virtual professional community of practice (VCoP), HOBE+, was set up in 2011 to foster and facilitate innovation . It was aimed at all primary care professionals of the Basque Public Health Service (Osakidetza) in the provinces of Biscay and Araba. HOBE+ incorporated a innovation management process from the generation of ideas to their implementation.In 2015, based on its success, HOBE+ became a corporate tool in Osakidetza extending its radio of action to all employees and settings (primary and Hospital care).This manuscript objective is to assess, via a case study method, the process of developing and implementing a VCoP open to all primary care professionals in Osakidetza, including the take-up, participation and use of this VCoP in the first 15 months after its launch in October 2011. The usefulness of the VCoP was also assessed through a survey gathering the opinions of the professionals involved.The experience shows that it is possible to create a virtual CoP for innovation in primary care where professionals from different professional categories propose ideas for innovation that are ultimately implemented; a experience that had been later on refined and extended to all Osakidetza.

To explore and compare the impact of socio-economic deprivation on the occurrence of the major rheumatic and musculoskeletal diseases (RMDs) and health care costs.Data on diagnoses, socio-demographics and health care costs of the entire adult population of the Basque Country (Spain) was used. Area deprivation index included five categories (1 to 5 (most deprived)). Cost categories included primary and specialist care, emergency room, hospitalisations, and drug prescriptions. Twenty-nine RMDs were grouped into seven groups: Rheumatoid Arthritis, Spondyloarthritis, Crystal Arthropathies, Osteoarthritis, Soft Tissue Diseases, Connective Tissue Diseases, and Vasculitis. The relations between the deprivation and the occurrence of RMD and costs were explored in regression models adjusted for relevant confounders.Data from 1,923,156 adults were analysed. Mean age was 49.9 (SD18.4) years, 49% were males. Soft tissue diseases were the most prevalent RMD (5.5%, n=105,656), followed by osteoarthritis (2.2%, n=41,924). Socio-economic deprivation was associated with higher likelihood to have any of the 29 RMDs. The strongest socio-economic gradient was seen for the soft tissue diseases (OR 1.82 [95%CI 1.78;1.85], most vs. least deprived), followed by osteoarthritis (OR 1.59 [1.54;1.64]). Deprivation was also associated with higher costs across the majority of the conditions however patterns were more blurred, and inverse relationship was observed for connective tissue diseases, gout, hip osteoarthritis and undifferentiated (poly)arthritis.Socio-economic deprivation is associated with increased occurrence of all RMDs, and in most cases more deprived patients incur higher health care costs.

Introduction: The Public Telecare Service of the Basque Government (betiON) provides home care for dependent and older people through a technological device that guarantees a permanent connection with an interdisciplinary team of professionals who are trained in remote socio-health care. In 2013, the 77.57% of the telecare population were aged above 80 years, 80.69% of users were female and 65% lived alone. Most of the population of betiON lived in the most economically depressed areas. One of the main objectives of betiON is to promote the permanence of their users in their usual social environment. Moreover, this connection with health care devices allows implementing shared information systems with health and social data, which enable a characterization of the attended population and the development of integrated models for health and social provision. The users of telecare service have at least one of the following characteristics: People over 75 who live alone People over 65 who are in a situation of acknowledged dependency or in situation of vulnerability recognized by social services International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116558– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. People with intellectual, physical or sensory disability and recognized dependency at any degree People who have a diagnosed mental illness and present a situation of recognized dependency or risk of social exclusion. It is well known that multimorbidity, coexistence of two or more diseases, is very common in the older population and it negatively affects the quality of life related to health. Objectives: The purpose of this study is to describe the quality of life of telecare service users collected by EQ-3D questionnaire and to establish its relationship with multimorbidity. Methods: It will be extracted information from the stratification database of the Basque Country (PREST) of more than 30,000 users of betiON. PREST has been created to classify all Basque citizens based on their future health care needs in a hundred mutually exclusive groups, Adjusted Clinical Groups (ACG), provided by the case-mix developed at Johns Hopkins University (Baltimore). This database contains demographic, socioeconomic (deprivation index of the residence area) and clinical variables, from data registered in the MBDS and annotations in electronic health records of specialist care and primary care. To detect chronic disease, it will be used information about diagnoses and prescriptions. For quality of life related to health, it is using the EQ-3D questionnaire by telephone between the users of betiON . Also it will be collect social variables (family unit, heating system, use of social services...) Multiple regression analysis on EQ-3D index will be conducted to determine the simultaneous effect with chronic diseases, social and demographic variables on quality of life related to health in our study population. Results and Conclusions: The results will be presented at the Congress, as well as, future findings. Applications: This study will have applications in the development of specific interventions in subgroups with similar characteristics to improve the quality of life and for management of multimorbidity.

Introduction: Telecare Public Service of the Basque Government (betiON) is part of a comprehensive care model focused on the person, whose fundamental aspect is to address the social and health needs of people in a coordinated manner, both in preventive and in care aspect. Its connection with health care devices allows having information of systems which share data on health and social issues. This makes possible a characterization of the target population and the development of integrated health and social care provision models. This service is aimed at: People over 75 who live alone People over 65 who are in a situation of acknowledged dependency or in situation of vulnerability recognized by social services People with intellectual, physical or sensory disability and recognized dependency at any degree People who have a diagnosed mental illness and present a situation of recognized dependency or risk of social exclusion. The socio-health coordination has been turned into the adoption of various measures and it addresses objectives and actions for active aging, coordination of socio-health space, adequate International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116527– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. health care for the elderly, promotion of autonomy and respect for personal wills, the new technologies for quality of life, welfare, promotion of volunteering, and personal and intergenerational relationships Aims/Objectives: To encourage their users to stay in their usual environment To guarantee a continuity of care To reduce the need for face-to-face care To promote care in the home To orient patient/family in the decision of the health problem To increase cooperation and coordination between health professionals and social partners To facilitate communication between different health agents Results: In 2013, betiON (N=30,393) covered 6.99% of the population over 65 years of the Basque Country (3.31% in men and 9.94% in women). The 81% of users were women, the 77.57% were older than 80 years and the 65% lived alone. The users’ overall satisfaction level was 4.5 out of 5. betiON handled 2,000 incoming and 800 outgoing calls daily. In 2013, the ratio of outgoing calls per person was 1.3. The 87.33% of answered calls were resolved through telephone by telecom operators, and the 12.67% required to be referred to other services. The 8.69% of calls had a sanitary character (5.79% of health advice and 2.90% previous appointment), with a 58% of call resolution. In 2014, betiON is part of the European project titled Universal Solutions in Telemedicine Deployment for European Health Care (united4Health) of Competitiveness and Innovation Programme ICT-PSP 2012 call, as a provider of telecare and telehealth services for the Basque Health Service, for heart failure care. Conclusions: The coordination of social and health services through the connection of information systems and telecare as a platform of services offer significant opportunities for innovation in the intervention relating to this population.

Hospitalizations are undesirable events that can be avoided to some degree through proactive interventions. The objective of this study is to determine the capability of models based on Adjusted Clinical Groups (ACG), in our milieu, to identify patients who will present unplanned admissions in the following months to their classification, in both the general population and in subpopulations of chronically ill patients (diabetes mellitus, chronic obstructive pulmonary disease and heart failure).Cross-sectional study which analyzes data from a two year period, of all residents over 14 years old in the Basque Country (N = 1,964,337). Data from the first year (demographic, deprivation index, diagnoses, prescriptions, procedures, admissions and other contacts with the health service) were used to construct the independent variables; hospitalizations of the second year, the dependent ones. We used the area under the ROC curve (AUC) to evaluate the capability of the models to discriminate patients with hospitalizations and calculated the positive predictive value and sensitivity of different cutoffs.In the general population, models for predicting admission at 6 and 12 months, as well as long-term hospitalizations showed a good performance (AUC0.8), while it was acceptable (AUC 0.7 to 0.8) in the groups of chronic patients.A hospitalization risk stratification system, based on ACG, is valid and applicable in our milieu. These models allow classifying the patients on a scale of high to low risk, which makes possible the implementation of the most expensive preventive interventions to only a small subset of patients, while other less intensive ones can be provided to larger groups.

In 2011 advanced competences in nursing were defined and pilot tested in the Basque Healthcare System, in order to meet the needs of chronic patients. It is assumed that nursing professionals, in a functional sense, can fulfil a liaison role both within the health system and with external stakeholders. Integration between levels of care, the mobilisation of resources and case management are fundamental factors in achieving this objective. Background: In 2010, an overall strategy for tackling the challenge of chronicity was launched in the Basque Country. Its main objective was to drive the Basque Health Service (Osakidetza) towards improving care for patients with chronic illnesses (Department of Health and Consumer Affairs, Basque Government and Osakidetza, 2010). Under this strategy, there was a commitment to develop and implement advanced competencies in nursing, with the objective of introducing nursing roles to better meet the needs of chronic patients. Methods: To achieve this objective, a one-group pre-test and post-test pre-experimental design was adopted for this study. We used the SATISFAD questionnaire to assess the satisfaction of patients and caregivers, and the SF-12 and Barthel Index to measure quality of life and level of independence respectively. Results: The experience of introducing the new nursing competencies has been rated as very positive by the participating patients and those around them (their caregivers and families) as it is perceived to have resulted in care that is more personalised, better planned and focused on the patient than traditional healthcare. Nevertheless, the process was not found to have significantly improved patient perception of quality of life and level of independence. Conclusions: The implementation of advanced competencies in the Basque Country has shown that case management leads to improvements in social and health care for patients, and their caregivers and families, compared to traditional care.

To describe the current situation of self-management initiatives in Spain.We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords «paciente experto» (expert patient), «paciente activo» (active patient) and «apoyo al autocuidado» (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks.Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems.In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice.