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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2019;153:e49" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Shared care in polypathological patients: about intravenous iron" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e49" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Atención compartida en pacientes pluripatológicos: a propósito del hierro intravenoso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iciar Usategui-Martín, Mateo Martín-Merino, Luis Angel Sánchez-Muñoz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Iciar" "apellidos" => "Usategui-Martín" ] 1 => array:2 [ "nombre" => "Mateo" "apellidos" => "Martín-Merino" ] 2 => array:2 [ "nombre" => "Luis Angel" "apellidos" => "Sánchez-Muñoz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319302404" "doi" => "10.1016/j.medcli.2019.01.040" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319302404?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619304358?idApp=UINPBA00004N" "url" => "/23870206/0000015300000009/v1_201911071124/S2387020619304358/v1_201911071124/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e50" "paginaFinal" => "e51" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Rivilla Marugán, Saioa Zalba Marcos, José Antonio García Erce" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Laura" "apellidos" => "Rivilla Marugán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Saioa" "apellidos" => "Zalba Marcos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "José Antonio" "apellidos" => "García Erce" "email" => array:2 [ 0 => "ja.garcia.erce@navarra.es" 1 => "jagarciaerce@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Medicina Familiar y Comunitaria, Servicio Aragonés de Salud, Centro de Salud de Sabiñánigo, Huesca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dear Editor:</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to thank Dr. Usategui-Martín et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> team’s interest in our work and congratulate them on the results presented from their experience with high-dose intravenous iron therapy (IIT). Our modest results<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> together with theirs, confirm that coordination between hospital and primary care levels is as essential as safety and effectiveness in hospital administration of this type of treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We consider the initiative of the care continuity units (CCU) essential in the correct management of the <span class="elsevierStyleItalic">“complex pluripatological patient”</span>. It is a very interesting model that is exportable to other communities. This model is equivalent to one that Aragón is trying to establish: the complex chronic patient (CCP). Here, as in many other areas of health care, we must defend the equity and accessibility of society.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the Complex Hospital of the Community of Navarra, the Internal Medicine Service has the Outpatient and Pluri-pathological Section, which comprises the Home Hospitalisation Unit and the Chronic-Pluripathological Day Hospital. In October 2014, IIT began to be administered at the day hospital, and in 2015 IIT was administered on an outpatient basis to those patients who were unable to travel to the hospital due to either physical and social limitations. The first IIT session is administered at the hospital and if there are no complications, subsequent sessions are administered at home. Administration is carried out by nurses who remain with the patient during the entire infusion session (infusion takes approximately 20 min). They carry a kit that contains medication in case of a possible adverse reaction. To date there have not been any serious adverse reactions (personal communication from Dr Ruiz Castellano, Head of Section for Dr Zalba Marcos’ Unit). There is also, in the same location, the Multipurpose Day Hospital, which is independent of the Internal Medicine Service, where other services also administer IIT and other treatments, especially nutrition and pulmonology. Both outpatient and day hospitals have been functioning for years with increasing activity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of IIT in patients with impaired baseline situations is one of the ‘star’ cases in which its indication from primary care can result in extra quality of life, improvement of asthaenia, heart failure, etc., as unnecessary referrals or transfers are avoided, and they do not need to ask their a companion or family member to take time off work. However, this would not be the only type of patient that would benefit from IIT prescription; young patients who work may see their recovery time shortened, and in turn reduce the time they need to take time off work; women in their second ° and third ° trimester of pregnancy (experience in Navarre) or patients scheduled for multimodal rehabilitation prior to surgery (ERAS programmes or <span class="elsevierStyleItalic">Patient Blood Management</span> programmes)<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or after recovery.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is proven experience in outsourcing certain treatements that have always traditionally been administered at the hospital, such as blood transfusion; they are carried out professionally and safely and have great acceptance in an outpatient context, such as in the Navarre or Cantabrian experience.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We must continue to work on removing barriers, integrating both sectors, ensuing the hospital ‘flows’, and even take IIT to primary care, as we have done with therapeutic bleeding and anticoagulation control. We believe that we must create multimodal teams that integrate primary care and home hospitalisation, both for CPP management programmes and for anaemia management in Patient Blood Management programmes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">No external funding for this study was received. This article was written at the invitation of the journal without external influence.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dr. García Erce has managed grants, given talks, moderated tables at conferences and workshops or organised courses with scholarships or funding from Alexion, Amgen, Braun, Celgene, Ferrer, GSK, Inmucor, Jansen, Novartis, Octapharma, Sanofi, Sandoz, Terumo, Vifor and Zambon. The other authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack433323" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rivilla Marugán L, Zalba Marcos S, García Erce JA. Respuesta a «Atención compartida o integrada de los pacientes pluripatológicos: el caso del hierro intravenoso en atención primaria». Med Clin (Barc). 2019;153:e50–e51.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atención compartida en pacientes pluripatológicos: a propósito del hierro Intravenoso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Usategui-Martín" 1 => "M. Martín-Merino" 2 => "L.A. Sánchez-Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2019.01.040" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efectividad del tratamiento ambulatorio con hierro intravenoso en pacientes seleccionados de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Rivilla Marugán" 1 => "T. Lorente Aznar" 2 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2018.10.004" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From blood saving programs to patient blood management and beyond" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Ripollés-Melchor" 1 => "C. Jericó-Alba" 2 => "M. Quintana-Díaz" 3 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2018.02.027" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "151" "paginaInicial" => "368" "paginaFinal" => "373" "itemHostRev" => array:3 [ "pii" => "S0749806314007993" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Home transfusion: three decades of practice at a tertiary care hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. García" 1 => "A. Aguilera" 2 => "F. Antolín" 3 => "J.L. Arroyo" 4 => "M. Lozano" 5 => "P. Sanroma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/trf.14816" "Revista" => array:6 [ "tituloSerie" => "Transfusion" "fecha" => "2018" "volumen" => "58" "paginaInicial" => "2309" "paginaFinal" => "2319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30229938" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of the internist in the patient blood management program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Jericó Alba" 1 => "J.A. García Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2017.11.002" "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "150" "paginaInicial" => "469" "paginaFinal" => "471" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack433323" "titulo" => "Acknowledgements" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">This work is part of the Study Project <span class="elsevierStyleItalic">"Variability of haematimetric and haematological values in relation to environmental and geographical factors"</span> approved by the San Jorge de Huesca Hospital Research Committee. "LINDAnemic" group.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To Dr Teófilo Aznar Lorente, Family and Community Medicine, Aragonese Health Service, Sabiñánigo Health Centre, Huesca, Spain, co-author and fundamental member of the group.</p><p id="par0055" class="elsevierStylePara elsevierViewall">To Dr Ruiz Castellano of the Outpatient and Pluri-pathological Section of the Hospital Complex of Navarre, Navarre, Pamplona, Spain.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000009/v1_201911071124/S2387020619304383/v1_201911071124/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000009/v1_201911071124/S2387020619304383/v1_201911071124/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619304383?idApp=UINPBA00004N" ]
