array:24 [ "pii" => "S238702061930261X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.03.010" "estado" => "S300" "fechaPublicacion" => "2019-08-02" "aid" => "4805" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2019;153:112-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S002577531930199X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.03.002" "estado" => "S300" "fechaPublicacion" => "2019-08-02" "aid" => "4805" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2019;153:112-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 21 "formatos" => array:2 [ "HTML" => 10 "PDF" => 11 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Multidisciplinary care to older patients with multiple chronic conditions: A challenge for the health system" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "112" "paginaFinal" => "114" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Atención multidisciplinar a los pacientes con múltiples condiciones crónicas: un reto para el sistema de salud" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miquel Àngel Mas" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Miquel Àngel" "apellidos" => "Mas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S238702061930261X" "doi" => "10.1016/j.medcle.2019.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061930261X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531930199X?idApp=UINPBA00004N" "url" => "/00257753/0000015300000003/v1_201907170644/S002577531930199X/v1_201907170644/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020619302700" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.02.025" "estado" => "S300" "fechaPublicacion" => "2019-08-02" "aid" => "4822" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2019;153:115-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Surgical approach of non-small cell lung cancer with extrapulmonary metastasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "121" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordaje quirúrgico del carcinoma broncogénico de células no pequeñas con metástasis extrapulmonar" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gemma María Muñoz Molina, Ana Patricia Ovejero Díaz, Luis Gorospe Sarasúa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Gemma María" "apellidos" => "Muñoz Molina" ] 1 => array:2 [ "nombre" => "Ana Patricia" "apellidos" => "Ovejero Díaz" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319302337" "doi" => "10.1016/j.medcli.2019.02.025" "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/S0025775319302337?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302700?idApp=UINPBA00004N" "url" => "/23870206/0000015300000003/v1_201907260839/S2387020619302700/v1_201907260839/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020619302621" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.06.001" "estado" => "S300" "fechaPublicacion" => "2019-08-02" "aid" => "4519" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;153:106-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Evaluation of pain intensity in people with rheumatoid arthritis using the MOS intensity scale" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "111" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la intensidad del dolor en personas con artritis reumatoide mediante la escala de intensidad MOS" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1309 "Ancho" => 2000 "Tamanyo" => 104484 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagram of the MOS pain intensity scale confirmatory factor analysis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gabriel Horta-Baas, María del Socorro Romero-Figueroa" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Horta-Baas" ] 1 => array:2 [ "nombre" => "María del Socorro" "apellidos" => "Romero-Figueroa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775318302872" "doi" => "10.1016/j.medcli.2018.04.017" "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/S0025775318302872?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302621?idApp=UINPBA00004N" "url" => "/23870206/0000015300000003/v1_201907260839/S2387020619302621/v1_201907260839/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Multidisciplinary care to older patients with multiple chronic conditions: A challenge for the health system" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "112" "paginaFinal" => "114" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Miquel Àngel Mas" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Miquel Àngel" "apellidos" => "Mas" "email" => array:1 [ 0 => "miquelmas.mn.ics@gencat.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Barcelona, Catalonia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Atención multidisciplinar a los pacientes con múltiples condiciones crónicas: un reto para el sistema de salud" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Management of the rising prevalence of long-term chronic conditions in ageing populations is one of the most important challenges facing health care systems worldwide.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> The disease-centred approach, focused on improving single disease management and preventing the progression of specific chronic conditions,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> is not such comprehensive as needed for the clinical care of older patients with multiple chronic conditions (MCC). To define this group of people, two main clinical entities, multimorbidity<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> and frailty,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> need to be considered. Multimorbidity is defined as the presence of two or more chronic morbidities. It becomes progressively more common with age and it is associated with high mortality, reduced functional status, and with increased health care use, including high consume of drugs for chronic treatment. Several interventions<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,6</span></a> have been evidenced supporting multidisciplinary clinical management of patients with multimorbidity and polypharmacy. The majority of them have been evaluated in primary care and community settings.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> Frailty is defined as a state of increased vulnerability to poor resolution of homoeostasis after a stressor event, which increases the risk of adverse outcomes, including falls, delirium, disability, and mortality, when frail person is exposed to a stressor. It can occur as the result of a range of diseases and medical conditions. It is key, to develop an early detection strategy and proactive approach after its identification, in order to prevent morbidities and progression of complexity.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> In the case of interaction between multimorbidity and frailty, persons with MCC may have a trajectory of decline in health and functional status, and a greater likelihood of disability, that should be considered as an additional clinical entity,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> leading to high level of health and social needs. In these populations, changes in the provision of care should be centred not only on clinical decision making, with participation of patients and caregivers in care planning,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> but also in quality measurement, health care delivery, and payment.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a clinical perspective, different comprehensive multidisciplinary care models, tailored to patients with chronic conditions, have been evaluated in the last decades.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> These models embrace a huge range of clinical interventions delivered in several settings. Primary care and community schemes include interdisciplinary home based primary care, and case management or care management in the community, between others. Outpatient care comprehends disease management programmes, caregiver support, comprehensive geriatric evaluation and management, and pharmaceutical care. Inpatient care, hospital-based follow-up and coordination interventions entail comprehensive geriatric assessment inpatient care,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> provided in acute geriatric units or by mobile teams, early discharge (and admission avoidance) hospital-at-home, and transitional care. Finally, several programmes have been designed for the care of vulnerable patients in nursing homes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue, Nieto-Martín et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> published a quasi-experimental pre-post study that evaluated a multidisciplinary protocol applied to a group of older patients with MCC. It showed a reduction in hospital admissions and in days of hospitalisation during a 12-month follow up period. The protocol was mainly activated after a hospital-based service contact. The intervention was pivoted on outpatient care and it was centred on the following points: proactive identification from GPs of patients at risk; multidimensional assessment focused on medical issues, functional and cognitive capacity evaluation; assessment and follow-up intervention by an internal medicine physician (pharmacological and non-pharmacological therapy assessment at inclusion, follow-up medical visit after inclusion, rapid activation of outpatient visit after an acute crisis, and direct access to inpatient care when necessary); hospital pharmacist intervention (pharmacological treatment evaluation and intervention on compliance when necessary); and proactive nursing care intervention (including continuity of care plan communication from hospital to primary care, and educational workshops with patients and caregivers).</p><p id="par0020" class="elsevierStylePara elsevierViewall">This intervention is a remarkable example of outpatient care tailored to patients with MCC, with a relevant role of hospitalists and hospital staff. It has similarities with other transitional experiences developed for intense care after an acute increase of complexity related to a hospital admission. In an urban area in the North of Barcelona, Pacho et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> developed a heart failure (HF) clinic protocol that included a face-to-face early visit (within 7 days), HF nurse education, treatment titration, and intravenous medication when needed. It was a prospective study that enrolled patients with MCC discharged from internal medicine or geriatric wards after HF hospitalisation. This intervention focused on the care of older patients with MCC at risk of readmission showed a significant reduction in early readmissions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">These types of outpatient interventions are aligned with the system components of the Chronic Care Model (CCM),<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> which is an evidence based, conceptual framework that describes changes to the healthcare system that help practices to improve outcomes among patients with chronic illness. Key components of the Nieto-Martín et al. protocol, linked to CCM are: (a) Strong self-management support, with provision of information and support to enable patients and families to care better for their illness; (b) Changes in delivery system design, with key roles of non-physician professionals, such as intense care management by nurses who provide close follow up and help to increase adherence; (c) Support to clinical decisions, especially in case of an acute crisis and in rapidly increasing complexity; (d) Access to clinical information systems to provide timely useful data about patients and populations risk. The main goal of the design of care models in patients with chronic illness is to build a productive and satisfying clinical interaction between informed activated patients and prepared proactive teams. From its development, the CCM components have been evaluated, based in an outpatient approach, in patients with chronic morbidities suffering specific individual conditions, but little is known in complex cases due to multimorbidity or frailty. In this sense, the evaluation of a multidisciplinary care intervention in a population of patients with MCC is an important strength of this work.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the literature, several initiatives have been published to validate similar multidisciplinary care in the community, by intense primary care programmes.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Patients with MCC at high risk for hospitalisation or death were enrolled in a specific programme that addresses medical and social needs, and coordinates care across settings, with a broad range of services. Home-based primary care<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> had been evaluated by different groups in the Veterans Affairs system programmes, with positive results on reductions in hospital utilisation, but also in other outcomes as quality of life or patient satisfaction on care of patients. Clinics-based intensive primary care, and other primary care augmentation models, such as PACE or GRACE programmes in the US, demonstrated, between others, reductions in hospitalisation rates and/or emergency department visits. All these interventions, share common key components: care is based on comprehensive assessment led by a multidisciplinary team; the assessment is followed by an individualised care plan, and its evolution is monitored in regular interprofessional care meetings; there is a strong health educational intervention to patients and caregivers on their chronic conditions; it secondarily leads to a major implication on care decisions and advanced care planning; there is a clear pathway in case of crisis (rapid contact with the health team with a rapid response of the staff); in most cases there is an alternative way to provide acute care different from the usual inpatient care<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a>; in case of hospital admission there is an early discharge pathway, with strong follow-up by nurses and other professionals during the transitional care; in case of progression of advance illness the care is focused on symptoms control and in facilitating home stay in end-of-life stages.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Based on evidence, it seems clear that the future care of older patients with MCC will include the clinical components discussed in this paper, and that it will be provided by multidisciplinary teams outside the hospital. These interventions will assure a special role of nursing care and intense clinical follow-up, to respond not also to health needs but also to social aspects related to the health trajectory, and to facilitate a right decision making process.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> In their paper, authors referred as a limitation that the involvement of primary care physicians would have been greater. They discern that it is key that person centred care is supported by policy reforms to strength the primary care system, encourage care coordination, and promote care management, to help improve chronic care and to rationalise health and social related costs. The challenge for the future health system is to integrate these valuable interventions in the primary care follow-up, with an open collaboration between professionals working in different parts of the system, for addressing the complex needs of these vulnerable patients and their caregivers, based on the goals of increasing both, quality of life and time spent at home.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence, expenditures, and complications of multiple chronic conditions in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Wolff" 1 => "B. Starfield" 2 => "G. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2002" "volumen" => "162" "paginaInicial" => "2269" "paginaFinal" => "2276" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caring for patients with multiple chronic conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.E. Tinetti" 1 => "A.R. Green" 2 => "J. Ouellet" 3 => "M.W. Rich" 4 => "C. Boyd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M18-3269" "Revista" => array:2 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2019" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Barnett" 1 => "S.W. Mercer" 2 => "M. Norbury" 3 => "G. Watt" 4 => "S. Wyke" 5 => "B. Guthrie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "37" "paginaFinal" => "43" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty in elderly people" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Clegg" 1 => "J. Young" 2 => "S. Iliffe" 3 => "M.O. Rikkert" 4 => "K. Rockwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2013" "volumen" => "381" "paginaInicial" => "752" "paginaFinal" => "762" "itemHostRev" => array:3 [ "pii" => "S0268960X11000816" "estado" => "S300" "issn" => "0268960X" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "American Geriatrics Society expert panel on the care of older adults with multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "E1" "paginaFinal" => "E25" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical assessment and management of multimorbidity: NICE guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Kernick" 1 => "C.A. Chew-Graham" 2 => "N. O’Flynn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Gen Pract" "fecha" => "2017" "volumen" => "67" "paginaInicial" => "235" "paginaFinal" => "236" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for improving outcomes in patients with multimorbidity in primary care and community settings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Smith" 1 => "E. Wallace" 2 => "O.T. Dowd" 3 => "M. Fortin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2016" "volumen" => "3" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty consensus: a call to action" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.E. Morley" 1 => "B. Vellas" 2 => "G.A. van Kan" 3 => "S.D. Anker" 4 => "J.M. Bauer" 5 => "R. Bernabei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Med Dir Assoc" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "392" "paginaFinal" => "397" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.P. Fried" 1 => "L. Ferrucci" 2 => "J. Darer" 3 => "J.D. Williamson" 4 => "G. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Gerontol A: Biol Sci Med Sci" "fecha" => "2004" "volumen" => "59" "paginaInicial" => "255" "paginaFinal" => "263" "itemHostRev" => array:3 [ "pii" => "S0145212613000763" "estado" => "S300" "issn" => "01452126" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Framework for decision-making for older adults with multiple chronic conditions: executive summary of action steps for the AGS guiding principles on the care of older adults with multimorbidity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Boyd" 1 => "C.D. Smith" 2 => "F.A. Masoudi" 3 => "C.S. Blaum" 4 => "J.A. Dodson" 5 => "A.R. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jgs.15809" "Revista" => array:2 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2019" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Designing health care for the most common chronic condition-multimorbidity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Tinetti" 1 => "T.R. Fried" 2 => "C.M. Boyd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2493" "paginaFinal" => "2494" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful models of comprehensive care for older adults with chronic conditions: evidence for the Institute of Medicine's “retooling for an aging America” report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Boult" 1 => "A.F. Green" 2 => "L.B. Boult" 3 => "J.T. Pacala" 4 => "C. Snyder" 5 => "B. Leff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2009" "volumen" => "57" "paginaInicial" => "2328" "paginaFinal" => "2337" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comprehensive geriatric assessment for older adults admitted to hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Ellis" 1 => "M. Gardner" 2 => "A. Tsiachristas" 3 => "P. Langhorne" 4 => "O. Burke" 5 => "R.H. Harwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2017" "volumen" => "9" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multidisciplinary approach for patients with multiple chronic conditions: IMPACTO study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Nieto-Martín" 1 => "L. De la Higuera-Vila" 2 => "M. Bernabeu-Wittel" 3 => "M.A. González-Benitez" 4 => "E.R. Alfaro-Lara" 5 => "M.A. Barón-Ramos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2019.01.014" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Bar)" "fecha" => "2019" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An early post-discharge intervention planned to reduce 30-day readmissions in old and frail heart failure patients remains beneficial at 1 year" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Pacho" 1 => "M. Domingo" 2 => "R. Núñez" 3 => "J. Lupón" 4 => "E. Vela" 5 => "A. Bayes-Genis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Esp Cardiol (Engl Ed)" "fecha" => "2018" "itemHostRev" => array:3 [ "pii" => "S1470204509700038" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving the quality of health care for chronic conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.E. Epping-Jordan" 1 => "S.D. Pruitt" 2 => "R. Bengoa" 3 => "E.H. Wagner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Qual Saf Health Care" "fecha" => "2004" "volumen" => "13" "paginaInicial" => "299" "paginaFinal" => "305" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of intensive primary care interventions: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.T. Edwards" 1 => "K. Peterson" 2 => "B. Chan" 3 => "J. Anderson" 4 => "M. Helfand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Gen Intern Med" "fecha" => "2017" "volumen" => "32" "paginaInicial" => "1377" "paginaFinal" => "1386" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of outcomes from home-based primary care programs for homebound older adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Stall" 1 => "M. Nowaczynski" 2 => "S.K. Sinha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2014" "volumen" => "62" "paginaInicial" => "2243" "paginaFinal" => "2251" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of a hospital-at-home integrated care program as alternative resource for medical crises care in older adults with complex chronic conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.À. Mas" 1 => "S.J. Santaeugènia" 2 => "F.J. Tarazona-Santabalbina" 3 => "S. Gámez" 4 => "M. Inzitari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jamda.2018.06.013" "Revista" => array:6 [ "tituloSerie" => "J Am Med Dir Assoc" "fecha" => "2018" "volumen" => "19" "paginaInicial" => "860" "paginaFinal" => "863" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30268290" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Muth" 1 => "J.W. Blom" 2 => "S.M. Smith" 3 => "K. Johnell" 4 => "A.I. Gonzalez-Gonzalez" 5 => "T.S. Nguyen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Intern Med" "fecha" => "2018" "volumen" => "285" "paginaInicial" => "272" "paginaFinal" => "288" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack418916" "titulo" => "Acknowledgment" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">I would like to thank Prof. Ramón Miralles (Universitat Autònoma de Barcelona and Institut Català de la Salut) for his support in the revision of the evidence cited in this editorial.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000003/v1_201907260839/S238702061930261X/v1_201907260839/en/main.assets" "Apartado" => array:4 [ "identificador" => "46797" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000003/v1_201907260839/S238702061930261X/v1_201907260839/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061930261X?idApp=UINPBA00004N" ]
Journal Information
Vol. 153. Issue 3.
Pages 112-114 (August 2019)
Vol. 153. Issue 3.
Pages 112-114 (August 2019)
Editorial
Multidisciplinary care to older patients with multiple chronic conditions: A challenge for the health system
Atención multidisciplinar a los pacientes con múltiples condiciones crónicas: un reto para el sistema de salud
Visits
2
Miquel Àngel Mas
Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Barcelona, Catalonia, Spain
This item has received
Article information
These are the options to access the full texts of the publication Medicina Clínica (English Edition)
Subscriber
Subscribe
Purchase
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail