Complex chronic internal medicine patients

Internal medicine doctors Spanish Society of Internal Medicine (SEMI) participated last Friday and Saturday in the IX complex meeting of the chronic patient of SEMI, to pay attention to the novelties in the approach and management of this type of patients, which are encountered more and more frequently in the Internal Services of hospitals in the country. At this meeting it was revealed that “61 percent of patients admitted to Internal Medicine are already complex chronic and 40 percent are multipathological”, according to data from the Cronicom study conducted within the Multipathological and Elderly Patient Group of SEMI.

These are patients with a high burden of Chronic diseaseusually in old age, often fragilityreduction of personal autonomydeterioration functional Y cognitivepolypharmacy and with high needs for social support and social health resources.

Patient multipathological is the one who “has two or more chronic diseases a complex that develops over the years, usually from a group of pathologies that are characterized by a significant deterioration in the quality of life”. But in pluripathology, in addition, there is usually a special sensitivity Y clinical weakness. It is important to identify those patients who have “a frequent need for care due to exacerbations and the appearance of interconnected pathologies that worsen their situation, with progressive functional deterioration and a high risk of falling into the cascade of addictions and disabilities”. The latter are complex chronic patients (CCP).

As highlighted at the meeting, profile of complex chronic and multipathological patients hospitalized in internal medicine services changed in the last years. “They are now older, more functionally disabled, dependent and at higher risk of prognostic stratification,” he says. Roman cubic columncoordinator of SEMI’s Multipathology and Elderly Patient Group and head of the Internal Medicine Service at Infanta Cristina University Hospital. from Parla.

The most common pathologies in chronic patients

The most common pathologies of complex chronic patients with multiple pathologies admitted to Internal Medicine Services are the diseases cordial (68 percent), followed by the disease chronic kidney (49 percent), diseases neurological (43 percent) and respiratory (32 percent). In addition, 60 percent have a high degree of dependence on basic activities of daily living (ABCV).

“This population exists High death rate at admission and at clinical follow-up, low quality of life related to perceived health and high prevalence of caregiver dependence. It presents a special sensitivity and clinical instability, which leads to frequent care seeking,” he recalls. Pilar Roman Sanchezmember of internal medicine of SEMI and coordinator of the IX complex meeting of chronic patients.

During the meeting, emphasis was placed on ” global multidimensional assessment” should be key in dealing with these patients and that a “strategy is needed where they are truly at the center of the system”. “It is the health system, not the patient, that must adapt to offer the best care and avoid harm to the patient himself. Cooperation with other services, through interdisciplinary teams and, above all, close and constant liaison 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 levels of care

In Kubo’s words, “every patient should have individual plan and is shared between different levels of care, which promotes empowerment of the patient or carer and specifies actions to be taken in case of concern due to possible decompensation”.
In these patients, moreover, Roman recalls that “it is important avoid hospitalization to the extent possible, as the loss of functionality that occurs during hospitalizations has been proven; promote specific care programs during admission to avoid functional deterioration and avoid the fragmentation of multiple consultations, which increases the number of hospital visits to the detriment of quality of life and the risk of polypharmacy”.

So much Roman cubic column What Pilar Roman SanchezS Jesus Dies Manglanopresident of SEMI, were responsible for discovering 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 paradigm shift after a pandemic.