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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”.