Miguélez-Chamorro Angélica, Casado-Mora María Isabel, Company-Sancho María Consuelo, Balboa-Blanco Edelmiro, Font-Oliver María Antonia, Román-Medina Isabel Isabel
Servicio de Salud de las Islas Baleares, España.
Estrategia de Cuidados de Andalucía, Servicio Andaluz de Salud, España.
Enferm Clin (Engl Ed). 2019 Mar-Apr;29(2):99-106. doi: 10.1016/j.enfcli.2018.08.005. Epub 2018 Sep 13.
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.
复杂慢性病在人生各阶段的患病率不断上升、人口逐步老龄化、共病现象普遍、多种药物联合使用以及自主性丧失，引发了社会的新需求。当前的护理模式未能以有效或可持续的方式满足这些需求。患有复杂慢性病的人很脆弱，随着疾病进展他们的健康状况会恶化，他们需要个性化且协调的专业护理，这种护理要考虑到疾病的进展、过渡情况以及患者的偏好。确定一种新的护理范式作为项目和行动的框架至关重要，这些项目和行动应得到推动，以实现针对处于人生各阶段的复杂和晚期慢性病患者的横向、可持续且高质量的护理。不同研究表明，病例管理在质量、安全性和成本效益方面具有附加价值。然而，其在西班牙的实施情况参差不齐且各不相同，并且尚未制定相关法规来使这一新的护士角色稳定下来。如今，卫生部和自治区有责任制定法规，并将病例管理护士/高级执业护士这一角色制度化，明确界定其专业能力和职责，就像其他国家所做的那样。
