La enfermería en los nuevos modelos de atención a la cronicidad. La telemedicina como

herramienta de soporte

D.U.E., MSc. Carme HernándezCoordinación Atención IntegradaDirección Médica y de Enfermería

Hospital ClínicBarcelona

Profesionales: Telemedicina, capacitación, nuevos rolesProfesionales: Telemedicina, capacitación, nuevos roles

Agenda

El paciente crónico ¿Es el motivo?

Capacitación, nuevos roles

Nuestra experiencia

Conclusiones

Factores de cambio de los sistemas de Salud

Current Fragmentation of Care

Patients experience and clinicians operate in “silos” of care.

Referral networks are large and often

depersonalized.

Pham HH, O'Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. Feb 17 2009;150(4):236-242.

Barreras por parte de los profesionales, ciudadanos, sistemas de pago y de las TICsBarreras por parte de los profesionales, ciudadanos, sistemas de pago y de las TICs

Wagner EH. Chronic disease management: What will it take to improve care for chronic illness?Eff Clin Prac 1998;1(1):2-4.http://www.improvingchroniccare.org

Integrated Care Definition

Concept bringing together inputs, delivery, management andorganization of services related to diagnosis, treatment, care,

rehabilitation and health promotion.

Integration is a means toimprove services in relation to access, quality, user satisfaction and

efficiency.

Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization,

Copenhagen, 2002, EUR/02/5037864

Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization,

Copenhagen, 2002, EUR/02/5037864

Atención de calidad para la cronicidad

La transformación transversal de la organización sanitaria.

La introducción de Tecnologías de la información y de la comunicación (TIC's) específicamente dirigidas a mejorar la atención a los pacientes con enfermedades crónicas y a facilitar el trabajo de los profesionales.

Una apuesta decidida para desarrollar el trabajo en equipo.

Juan J Baztán et al. BMJ 2009;338:b50

TThhee SScceennaarriioo

Agenda

El paciente crónico ¿Es el motivo?

Capacitación, nuevos roles

Nuestra experiencia

Conclusiones

Training, education, and skill set of today’s health care personnel is not adequate to manage patients with chronic conditions.

There is general consensus that to provide effective health care for chronic conditions, the

skills of health professionals must be expanded to meet these new complexities.

Judith Oulton. Chief Executive Officer.International Council of Nurses

Five basic competencies for caring patients with chronic disorders

Five basic competencies for caring patients with chronic disorders

Competence 4. Information and communication technology

(are essential for organizing and monitoring patients’ responses to treatments and outcomes)

Designing and using patient registries Using computer technologies Communicating with partners

(The potential to use mobile phone text-messaging technology to remind patients about appointments, medication refills, or test results, is virtually

untapped)

Basic skills: (using word-processing and data analysis software; searching online and internal databases; retrieving and managing data; being aware of data security systems

related to the use of patient information. …)

Institute of Medicine. Health professions education: A bridge to quality. Washington DC, The National Academies Press, 2003; O’Neil EH and the Pew Health Professions Commission. Creating health professional practice for a new century. San Francisco, Pew Health Professions; Commission, 1998; Forsstrom J, Rigby M.

TEAC-Health: Research-based recommendations for European certification of health telematics services. Studies in Health Technology and Informatics, 2000, 77:288–292

Del hombre-filósofo a la medicina-ciencia y

de la mujer-cuidadora a la enfermería-arte y ciencia

Licenciatura

Incorporación de las TIC

Carrera Profesional

Nursing leadership: bringing caring back to the future. Alison Kitson. Qual Health Care 2001;10:ii79-ii84 doi:10.1136/qhc.0100079

Career, Training & Certification

Certification in nursing informatics

Recommendations of the International Medical InformaticsAssociation (IMIA) on education in health and medical informatics

Educational needs for health care professionals to acquire knowledge and skills in ICTs.

Different levels of education, respectively stages of career progression

Various education methodologies are needed to provide the required theoretical knowledge, practical skills and mature attitudes.

Alternate routes to different types of specialization will depend on career choice. The majority of health care professionals need to know how to efficiently and responsibly use information and communication technology, but only a few will choose to have accredited specialization in this field.

Recommendations of the International Medical Informatics Association (IMIA) on Education inBiomedical and Health Informatics. First Revision. J. Mantas et al. Methods Inf Med 2010; 49: 105–120

Keep-in-Touch care

AssessmentScreening via questionnaireClinical view via screen

Self-management supporting presenceVirtual presenceIntervention when risks are signaledPatient feels the need for contactRelapse prevention

Tele-monitoring and tele-nursing (knowledge, symptoms, behavior)

Prevent derailmentSupport ADLAnswering and monitoring questions“missed” symptoms

CareSpecialized information on demandSpecialized information on websiteAdvice for social needsTriageSelf-management advice or second opinion

Putting information atthe heart of nursing care

When nurses are ICT innovators, Healthcare results will change

Las grandes razones para apostar por la enfermería y telemedicina

Reputación digital A pie de cama las 24 horas del día Capacidad de liderar grupos y de trabajo en equipo Evaluación global del paciente y capacidad para planificar

cuidados Paciente activo (e-patients) Acceder a la información relevante Intervenciones basadas en la evidencia Facilitar el intercambio de información

Agenda

El paciente crónico ¿Es el motivo?

Capacitación, nuevos roles

Nuestra experiencia

Conclusiones

Centro de control de llamadas

Historia Clínica única

Profesionales

Pacientes

Adaptation of health services to chronic patientsshared care arrangements across the system

Patient

Consultant

Relatives & care givers

PrimaryCareTeam

Mobile teams

Emergency team

CaseManager

Home

Primary Care

Hospital

Services

providers

Identificacióndel caso

Seguimiento

Definición Plan de trabajo

Evaluacióndel caso

Alta del proceso agudo

Basadas en la evidencia

Cuestionarios validados

Intervenciones individualizadas

Control de calidad

Utilización de las TICs como herramientas de soporte

Modelo de atención

Seguimiento post alta hospitalaria

Mobile technology: patient’s satisfaction

Esquema del Modelo de Servicio de Rehabilitación Pulmonar

Uso intensivo de materiales de educación sanitaria en formato video o multimedia

Redes de enfermedades

crónicas

Redes de enfermedades

raras

Redes de hábitos

saludables

Redes sociales de pacientes

Results

Clinical effectiveness

Changes in life style

Patient satisfaction

Cost control

Lessons learnt

Need for integration of ICT tools

Sustainability of the new models of care

A cultural change of the professionals is mandatory

Extensive adoption

Medical devices must meet real needs andprovide clear value

(Understanding of the particular needs of health professionals and patients)

The urge to apply technologies without proper identification and understanding of the most compelling needs is a frequent source of failure for medical innovation.

Training and fostering of collaboration with engineers health care professionals, business and design strategists and social scientists are crucial to the development of scalable, cost effective devices.

Assessing medical needs, building capacity and promoting cost-effective innovation will help in realizing technology’s potential for achieving better health in chronic patients.

Substantial evidence indicates that when the value of improved quality of life and productivity are considered, investments in health technology offer great returns.

Health Technologies and Innovation in the Global Health Arena. Sidhartha R. Sinha, M.D. and Michele Barry, M.D. NEJM 365;9 2011; WHO. First WHO global forum on medical devices: context, outcomes, and future actions. 2011;

Health, retirement needs challenge an aging America. Press release of the National Institute on Aging, Bethesda, MD, September 28, 2004 (http://www.nia.nih.gov)

Barreras para el uso de las TICs

Entender los beneficios

Aumento cargas de trabajo

Inter-operabilidad entre las diferentes plataformas

Temas éticos y de confidencialidad

Falta de un trabajo conjunto

Falta de entrenamiento

Adaptación en función de las necesidades de profesionales y pacientes

Ball MJ, et al. Methods Inf Med 2008; 47: 4–7; Hersh W. JAMA 2004; 292: 2273–2274; Hersh W. J Am Med Inform Assoc 2006; 13: 166–170; Hersh W. Yearb Med Inform

2008. pp 157–164.

Agenda

El paciente crónico ¿Es el motivo?

Capacitación, nuevos roles

Nuestra experiencia

Conclusiones

Conclusions

The transition from acute to chronic health problems places a new and different set of demands on the health care workforce.

In addition to skills that facilitate the diagnosis and treatment of acute illness and injury, today’s workforce needs a core set of competencies that will yield better outcomes for patients with chronic conditions.

Medical devices must meet real needs andprovide clear value.

“Nada cambia sin una transformación personal”.

ÉxitoEntrenamiento duro

Trabajo

Espíritu de equipo

chernan@clinic.ub.eschernan@clinic.ub.es