The SEMI deals with novelties regarding complex chronic patients.
Internal medicine doctors Spanish Society of Internal Medicine (SEMI) have participated last Friday and Saturday in the IX Complex Chronic Patient Meeting of the SEMI, to address novelties regarding the approach and management of this type of patient, which is increasingly common in the Internal Medicine Services of the country’s hospitals. In this meeting, it has been revealed that “61 percent of patients admitted to Internal Medicine are already complex chronic and 40 percent are pluripathological”, according to data from the Cronicom study, carried out within the Group of Multipathological and Elderly Patients of the SEMI.
These are patients with a high burden of chronic diseaseusually elderly, frequent fragilitydecrease in personal autonomydeterioration functional y cognitivepolypharmacy, and with high needs for social support and socio-health resources.
Patient pluripathological is one who “has two or more chronic diseases complex that evolve over the years, generally from a group of pathologies that are characterized by producing a significant deterioration in quality of life”. But in pluripathology, in addition, there is usually a special susceptibility y clinical frailty. It is important to identify those patients who have “a frequent demand for care due to exacerbations and the appearance of interrelated pathologies that aggravate their situation, with progressive functional deterioration and a high risk of falling into the dependency and disability cascade.” The latter are complex chronic patients (CCP).
As highlighted at the meeting, the profile of complex chronic and polypathological patients hospitalized in Internal Medicine services changed in recent years. “Now they are older, more functionally impaired, dependent, and have a higher risk prognostic stratification,” he says. Roman Cube Pillarcoordinator of the Group of Multipathological and Elderly Patients of the SEMI and Head of the Internal Medicine Service of the Infanta Cristina University Hospital of Parla
The most prevalent pathologies of chronic patients
The most prevalent pathologies of complex chronic patients with multiple pathologies admitted to the Internal Medicine Services are the diseases heart (68 percent), followed by disease chronic kidney (49 percent), diseases neurological (43 percent) and respiratory (32 percent). In addition, 60 percent have a high degree of dependency for basic activities of daily living (ABCV).
“This population has a high mortality during admissions and, in clinical follow-up, a low quality of life related to perceived health and a high prevalence of dependence on the caregiver. It presents a special susceptibility and clinical fragility that entails the frequent demand for care”, he recalls. Pilar Roman Sanchezinternal medicine member of SEMI and coordinator of the IX Complex Chronic Patients Meeting.
During the course of the meeting, the focus was placed on “the global multidimensional assessment” should be key in dealing with these patients and that “a strategy is needed in which they are truly the center of the system”. “It is the health system, and not the patient, that must adapt to offer the best care and avoid harm to the patient himself. Collaboration with other services, through interdisciplinary teams and, above all, the close and ongoing relationship with Primary Careis the key to keeping complex chronic patients in their place of residence for as long as possible, bringing health care closer to the patient’s home”.
Individualized plans between care levels
In Cubo’s words, “every patient should have a individualized plan and shared between the different levels of care that promotes the empowerment of the patient or their caregiver and specifies the actions to be taken in case of alarm due to possible decompensation”.
In these patients, in addition, Roman recalls that “it is important avoid hospitalization as far as possible since the loss of functionality that occurs during hospitalizations has been demonstrated; promote specific care programs during admission to avoid functional deterioration and avoid fragmentation in multiple consultations that increases the number of hospital visits to the detriment of quality of life and the risk of polypharmacy”.
So much Roman Cube Pillar as Pilar Roman SanchezWith Jesus Diez Manglanopresident of SEMI, have been in charge of inaugurating this IX Meeting of Complex Chronic Patients of SEMIin which they discussed aspects such as the future of Internal Medicine from the perspective of residents and young internists in the specialty, clinical reasoning and decision-making in complex clinical situations, health management and a paradigm shift following pandemic.
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