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Towards an Integrated and Health and Social Care | OMICS International
ISSN: 2167-1079
Primary Healthcare: Open Access
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Towards an Integrated and Health and Social Care

Pedro J Tarraga Lopez1*, Antonio Naharro Mañez2 and Francisco J. Vadillo Olmo3

1Servicio de Salud de Castilla-La Mancha, Health Center number 5, Albacete, Albacete 02005, Spain

2Family Physician EAP Zone 5 Albacete, Albacete 02005, Spain

3Manager Hospital Clinico in Valladolid, Spain

*Corresponding Author:
Pedro J Tarraga Lopez
Servicio de Salud de Castilla- La Mancha, Health Center number 5
Albacete, Albacete 02005, Spain
Tel: 34609080627
Fax: 3467225533
E-mail: [email protected]

Received date: May 18, 2016; Accepted date: June 16, 2016; Published date: June 23, 2016

Citation: Lopez PJT (2016) Towards an Integrated of Health and Social Care. Primary Health Care 6:229. doi:10.4172/2167-1079.1000229

Copyright: © 2016 Lopez PJT. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract: Let aimed towards an integrated and health and social care. And for this we will ask for a transparency in publishing data, a social participation to work with other sectors such as education and social services that requires patience, good public relations capacity, and believe in it and assign positions. A communication efforts internally. Ultimately we need to increase our work in prevention and health promotion. The main challenge is to strengthen the global health system, understood as a sum of efforts of various institutions and administrations. Innovation makes sense when it is practical, provides benefits over existing, and this makes it efficiently. The difference between evolutionary and disruptive innovations is given by the impact they produce. If we simply apply not disruptive innovations continuous improvement of the instruments, processes and procedures would take place. In the discussion of health managers is the concern for patient management of chronic health resources therefore needs as the cost involved and will assume in the next anon. In our health area of Albacete, after the administrative integration of primary and specialty care, it has designed a plan to complete and perfect this integration and adding social services system.


Social and health care; Epidemia gripe; A coordination of care levels

Situation in Albacete


The population dependent on the integrated area is 275,000 Albacete, so if approximately one to two and a half years according to the specialties million takes the complex pathology of inhabitants. Albacete is a city of 182,000 people served by nine primary care teams, a point guard primary care, 2 emergency units 112 and the Hospital University of Albacete, which is responsible for specialized care in two buildings Hospital Hospital Perpetuo Socorro General and the University of Albacete [1-3].

It consists of 8 nursing homes: 3 are public, 2 mixed management and 3 Private Management, this makes the complex geriatric care and the public has for the medical and nursing staff, personal care and other have private human resources on prescription and treatment is handled through the hospital and another prescription is done by the private doctor and then, if necessary, the recipe makes family doctors in health centers. Sanitary material and Joint Hospital serves private and public management of health centers.

General objective

Walking toward global integration: primary, specialized and social care Identify from the healthcare system what the needs of existing social care and, consequently, define and consolidate the main priorities and initiatives in which Management Integrated Management of Albacete should influence the coming years to give citizens assistance comprehensive, efficient and quality adapted to the people. Coordinating, at the same time, the use of health resources purely for the sake of more efficient care of citizens.

Specific objectives

• Conduct an assessment of the internal situation of geriatric care in Albacete.

• Conduct an assessment of the internal situation of geriatric care in Albacete.

• Define the lines of general, specific and initiatives to be used as a guide to action next four years.

• Determine an action plan in which health and social care coordinated to achieve greater efficiency and effectiveness in due initiatives prioritized according to their importance.


For the integration strategy including geriatric care in our community, it became necessary:

− First the integration of the two levels of primary-specialty care.

− Secondly implement a plan of chronic shared across the health system, the regional level and with different characteristics.

− Thirdly integration of the entire system of social services.

Primary integration specialist and family doctors

Integration with primary specialized care in Albacete has culminated in the creation of the Integrated Management by Order of 13/07/13 of Official Journal of Castilla la Mancha (OJCLM). The management integration of the two can be framed in the field of mergers. If we analyze how companies conduct their partnerships of companies 'management' see undertake, and internationally a series of actions that have common characteristics:

• Senior managers expect benefits for both companies, US partnerships collaborative looking for a quick profit, Asian establish long-term goals and are stable; and European intermediate form.

• The initial objective of collaboration increases with the knowledge of both and appears consequently increases value of collaboration.

• The control and management of the alliance requires a strong network of personal contacts to innovate and develop appropriate forms of management.

In the process of business integration are five levels:

1. Strategic Integration: Senior executives get through multiple contacts, perfect synergy.

2. Integration tactic: Intermediate and professional managers identify shared goals, share it and arrange actions methods.

3. Integration of operations: the channels through which people perform the tasks are established.

4. Integration interpersonal: relationships between members are established.

5. Cultural Integration: requires that people with communication skills to lead the establishment of a new business culture [4-7].

In our process of integration for many years we have been two management with organizational and functional independence. The link contact through standardized document, P10 that was the referral of patients in one way or another. For years we talk of coordination between levels as an element of improved attendance. With the creation of the Integrated Management of Albacete, as in the rest of the Community of Castilla la Mancha, in July 2013 we proceed to the strategic integration of both managements. One manager is appointed, adopting the management structure of the hospital and the hospital staff and managers relocating primary. Medical Director with four medical sub-addresses: Medical Assistant of surgical services, medical services deputy director, deputy director and deputy director of central services Primary. Director of nursing, with four sub-addresses. Address management with four sub-addresses. The headquarters of the new management and directors is the Hospital, the headquarters of the Management of Primary closes.

Management staff relocates Primary Hospital with "distress" consistent staff. The loss of its own management structure, the feeling of discrimination in respect of job in the same categories between hospital and primary; generate frustration expressed as: "The Hospital absorbs us", "no integration liquidation". It generates resistance. However at the same time they happen facts that come to consolidate a different management of the two sources, which is more than the sum of the two it encourages collaborative synergies with health outcomes. To achieve integration AP Specialized performs actions at different levels of integration.

Integration tactics

− Elections for Technical Assistance Commission on behalf of Primary are convened, and the new Commission which includes members of the two managers is constituted.

− Internal orders requiring equal consideration of rights of the same professional categories regardless of source management are developed.

− An Integrated Area Branch Elementary, under the direction of Assistant Director of Primary Medical unify process coordinator in this area while maintaining its organic dependence on medical and nursing addresses of the elements is constituted.

− The CADIF is created with a coordinator, as coordinating units Quality Teaching, Research and Training. Resources from Primary and all units are assigned and powers, functions and duties are defined.

− The UCAPI (Unit Continuity Asistencial Interna-Care Medicine Primary) as a unit of program support chronic, whereby the Internal Medicine Hospital liaises with the primary care professionals providing complementary diagnostic tests, treatments is created and even direct hospital admissions.

Operational integration

Interestingly professional dynamics and the need for it has made progress are made on this for many years. The protocols of scientific societies, often sets, and clinical pathways so willful agreed by professionals, shared clinical sessions or courses in various forums with multidisciplinary participation, have led to this development. However the new organizational situation has facilitated and amplified concrete measures are incorporated into the professional work:

− Access to digital mutual history: Clinical Viewer.

− Agreed protocols derivation:

Or musculoskeletal areas.

Or Dermatological

Or Digestive..., etc.

− Access to continuing education many center and many disciplines, face and "online".

Integration interpersonal

Logically this process develops at different speeds depending on the location of workers. Given that this Management Integrated Management of Albacete has approximately 4,000 employees can observe classes and departments where the process is completed and recent proof of this is that there has emerged a very explicit expression of disagreement between workers by assigning different incentive though was referring to agreements of 2012, since we "are already a management".

Cultural integration

Just as interpersonal integration takes time, but must be built with a communication strategy to accelerate the sense of belonging to the organization. Harnessing public events such as awards for research, 30th anniversary celebration events Hospital, logos, website, participatory development Mission, Vision and Values of the Integrated Management of Albacete. What we hope to provide this new business organization, Integrated Management of Albacete, the patient?

Among others these improvements:

Transversality and continuity: The patient is seen as a continuum without the place or the professional responsible for your care assume that this is interrupted. No compartmentalization or care steps and information about the pathology diagnostic tests or treatments is shared and allows tracking without duplication or unnecessary delays.

Quality: shared electronic medical records, protocols agreed, the optimal distribution of functions, have a quality department, including an improvement in quality.

Patient Safety: For all the above risks arising from duplications of techniques, tests and treatments are reduced.

Among others these improvements

Transversality and continuity: The patient is seen as a continuum without the place or the professional responsible for your care assume that this is interrupted. No compartmentalization or care steps and information about the pathology diagnostic tests or treatments is shared and allows tracking without duplication or unnecessary delays.

Quality: shared electronic medical records, protocols agreed, the optimal distribution of functions, have a quality department, including an improvement in quality.

Patient Safety: For all the above risks arising from duplications of techniques, tests and treatments are reduced.

Implementation of a chronic plan: Castilla-La Mancha, the definition of a new model of care health implies both a necessity address the crisis in which is immersed the current model and an opportunity, since it allows defining the keys to build the system integrated health. Autonomous Community our region, which will be implemented over the next years [8,9]. This new model of chronic care of Castilla- La Mancha seeks evolution the current model in which assistance is provided reactively to a proactive model. While the goal of the new model is to evolve the system to a proactive support, identifying people who need a health action, even before they have developed any pathology, grasp and incorporate a training process, in the case of healthy people with risk factors, or a standard of care in the case of persons who have developed one or more chronic diseases process.

Although the ultimate goal in the medium to long term is the transformation towards a welfare integrated model and its extension to the entire population of Castilla-La Mancha, regardless of whether it is chronic or not patients, it has chosen to take as a point of starting a set of chronic diseases and selected previously comorbidity, being the most prevalent among the citizens of our region and therefore causing the higher cost and level of care attendance among patients.

It is common to find different concepts of chronic patient. In Castilla-La Mancha, we opted for the Master Plan to this patientcentered with a long term (more than 6 months), whose purpose or duration cannot be predicted or never happen. The complexity of care for these patients reside, unlike the acute patient, chronic care requires continuous attention throughout the duration of the disease, and in many of these patients in which two or more diseases as they are source of various comorbidities, which complicates their care, which produce the changing situations that require orderly use of health resources, com-combined in many cases with the socio-health field.

• On the one hand they have prioritized a number of chronic from which processes is building the new model and should be the future of healthcare, "process management" so in our management have been and pillars care for processes such as:

− Integrated Pulmonary Chronic Obstructive Disease (COPD) attention.

− Integrated Diabetes Care: Early detection digital Retinography complications in primary care.

− Integrated in chronic heart failure and cardiac care processes (Project ACORD).

− Integrated care of chronic kidney disease.

− Process Mental Health Care severe mental disorder.

− Process Mental Health Early intervention in first psychotic episodes.

− Process Mental health disorders Common

− Common ophthalmological processes.

− Project Leads in Digestive, locomotor system.

• On the other hand and given the impact of care and quality of life of the people have selected these comorbidities associated with chronic conditions or aging:

Prevention and management of falls and associated injury.

Prevention and management of pressure ulcers and chronic wounds (Figure 1).


Figure 1: Prevention and management of pressure ulcers and chronic wounds.

System integration sociosanitario public and private coordination

Process to implement the scheme according to what has been done in Primary-Specialized unification:

• Strategic integration, tactical, operational.

• The transfer of the management of public housing to the Department of Primary Care Integrated Management Albacete would be the starting point of the process.

• Coordination of middle management, development of protocols, petitions, pharmacotherapeutic guide, pacts prescription, etc. would be the strategy to develop the privadas residences [10-12].

Sociosanitaria integration of a case:


− Is established in a hemi hospital floor in Residence to individually isolate diagnosed patients.

− From the management circuit supplies medication (Antiviral drugs, antipyretics, sera...) and material required set.

− A circuit supply influenza A diagnostic test such that is made in the residence and the test is carried in two hours maximum no definitive diagnosis is established.

− During the afternoons, Saturdays and Sundays they have no medical assistance at the residence is the covered medical SESCAM.


Visit the emergency room of the Hospital only 5 patients with complex pathologies, being admitted in March (one of whom died).

In the residence successfully treated and controls 35 inmates. 6 workers were diagnosed in the residence and were given time off work for 5 days to avoid infection.

Coordination between the three levels Hospital-Primary-Residence Geriatric not occurred they had come to the emergency department of Hospital 38 cases in addition to workers and probably would have been admitted more than half, given the complexity of pathologies of residents these data are compared by comparing with similar actions for similar epidemics in other people's homes ( "Enabled protocol Influenza a in the residence of Fuentes Blancas-Burgos-", "Flu Pandemic in nursing Zaragoza, January 2015").


Integration adequate health partner in Area Health Albacete is efficient for solving an epidemic of influenza A in a Geriatrics Home.


The starting point of any process of innovation in health management should be improving the health of the citizens it serves, both at the level of healthcare services, and a social level. And although health is priceless, it does have a cost, which must be managed effectively, efficiently and equitably way, with the intention of sustainable done in time, health systems can say that the quality is, at present, the key component of health strategies and coordination both levels makes an improvement in health care and social and partly a rationalization of public resources occurs [13-16].

Doctors, and nurses and other health professionals are members of professional groups, whose scale of values and beliefs have a powerful influence on the expectations and goals of your organization, they are therefore key to the functionality of the centers.

Public spending and social spending in the Spanish state (as a percentage of GDP) has been declining over the past six years, this decline justified as necessary to compete in a global and inclusive economy in the European Union [17-19].

A strong welfare state will provide a better guarantee productivity growth and human development, if it gets compare the increase in public and private consumption, with improvements in productivity. If properly compensated, considerations of equity and efficiency. And if the health aspect of the welfare state gives priority to effective health interventions, paying attention to their impact on both the health of the population and economic growth [20].

With our study we appreciate that by integrating levels of Primary Care and Specialty Care has been achieved: A significant improvement in mainstreaming and continuity of the patient is seen as a continuum without the place or the professional responsible for your care suppose this is interrupted. No compartmentalization or care steps and information about the pathology diagnostic tests or treatments is shared and allows tracking without duplication or unnecessary delays. There is a quality improvement with clinical history shared electronics, agreed protocols, the optimal distribution of functions, have a quality department, including an improvement of the quality and all this entails ensuring patient safety is reduce the risks of duplications of techniques, tests and treatments.

This creates the need to integrate social health services in the structure of the health system, as the population ages and increasingly higher proportion need be housed in residential centers for care.

With this new structure both private and public by relying Health Center whose Basic Zone located Geriatric homes this rationalization of human and material resources for improved attendance occurs. The doctor treating the patient is prescribed the treatment provided by the Integrated Management services. Currently the Public Service doctor makes the prescription or referral to the hospital in many cases not seen the patient who has been dressed by the doctor hired by the company that runs the residence [21].

Also in this new structure improved chronic care would occur because the internal of the residence would benefit from guidelines and protocols of Public Services that currently have no access. Also being polypharmacy patients would benefit from the activity of the Pharmaceutical Management in the management of pharmaceutical products.

Therefore, regarding this case and with the completion of the subsequent review, we highlight the need to coordinate the three levels of primary, hospital and social assistance towards an effective, efficient and equitable assistance.


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