Advanced practice in case management: An essential element in the new complex chronicity care model.

The increased prevalence of complex chronic diseases in all stages of life, the progressive aging of the population, the prevalence of multimorbidity, polypharmacy, and loss of autonomy, have given rise to new needs in society. The current model of care is failing to meet these needs in an effective or sustainable way. People with complex chronic diseases are vulnerable, they deteriorate as diseases progress, and they require individualized and coordinated professional care that takes into account the progression of the disease, transitions and people's preferences. It is essential to determine a new care paradigm as a framework for the projects and actions that should be promoted to reach transversal, sustainable and quality care directed at people with complex and advanced chronic diseases in all stages of life. Different studies show that case management is an added value in terms of quality, safety and cost-effectiveness. However, its implementation in Spain is uneven and heterogeneous, and no regulations have yet been developed to give stability to this new nurse figure. The Ministry and the Autonomous Communities now have the responsibility to create regulations and institutionalize the figure of case management nurses/advanced practice nurses, with a clear definition of their professional competences and functions, as has been done in other countries.