Monitoring and treatment of chronic patients through uHealth: Keys to sustainability (efficiency) and quality of care

  • Javier Cabo-Salvador Universidad Internacional de Andalucía [UNIA] / Universidad Rey Juan Carlos, España
  • José Manuel Velarde IHM-Medical Technology / DRIMAY Consultores España
  • Verónica Cabo Muíños Universidad Internacional de Andalucía / Universidad Católica Nordestana
  • Carlos de Castro Lozano Universidad Internacional de Andalucía / IHM-Medical Technology / Universidad a Distancia de Madrid / Universidad de Córdoba
  • Javier Ramos López Universidad Rey Juan Carlos, Madrid
Keywords: Elderly care; chronic patients management; ICT; uHealth; efficiency; health and social care.

Abstract

This paper proposes an integrated model of social-health resources management. The authors present the actual challenges for health care, in an environment characterized by longer life expectancy and an increase in the number of patients with chronic pathologies, in a scenario of both, economic and financial crises. Their presentation includes management and financial issues, and the technological trends –such as the development of personalized and regenerative medicine– which will lead to an increase in health spending. The task of facing these challenges, they explain, cannot be postponed, the goals should be to improve: the efficiency in the use of health resources, the quality of health care and the level of patient satisfaction. Finally, they present some concepts about the application of information and communications technologies in health, show its relationship with the chronic patient care and present both, the current management models for this type of patient and the new proposed model.

Downloads

Download data is not yet available.

Author Biographies

Javier Cabo-Salvador, Universidad Internacional de Andalucía [UNIA] / Universidad Rey Juan Carlos, España

Doctor in Medicine and Surgery from the Universidad Autónoma de Madrid (Spain). Fellowship in Cardiovascular Surgery at the Universities of Harvard (Cambridge, MA), Washington (Seattle, WA), Loma Linda (CA) and Pennsylvania (Philadelphia, PA). Medical Specialist in Cardiovascular Surgery. Honorary Doctor from the Universidad Central del Este and from the Universidad Católica Nosdestana (República Dominicana). Member of the New York Academy of Sciences and the International Who's Who Historical Society. Director of the Chair of Biomedical Research at the Universidad Internacional de Andalucía (Spain). Director of the Health Sciences Department and the Chair of Health Management at the Universidad de Madrid [UDIMA]. Director of the Chair of Biomedical Research at the Universidad Católica Nordestana. Director of the Cardiovascular Department at the Hospital Vithas Nisa Pardo (Aravaca, Spain).Member of the Health Advisory Council for the Government of Spain. Member of the National Commission of Specialists in Cardiovascular Surgery of the Ministry of Health; Advisory Member of the National Institute of Health Management. Member of the Panel of Experts of the Spanish Agency of Medicines and Health Products of the Government of Spain.

José Manuel Velarde, IHM-Medical Technology / DRIMAY Consultores España

Partner of Drimay Consultores. Specialist in planning, analysis, design, development and implementation of health and socio-health information systems. Degree in physics. Advanced Management Program (Instituto de Empresa). Member of the Academic Committee of the Master of the Universidad de Sevilla (Spain): Design, implementation and operation of socio-health information systems. Its activities include: the direction of the development and implementation of the Diraya program for the Andalusian Health Service; the design and implementation of the Citizen Attention Center (Salud Responde) for the of Health Counseling of the Junta de Andalucía; the Information Systems Plan for the Ministry of Health of Tunisia; the Integrated Health Management System for the State of Acre (Brazil); the electronic prescription systems; the elaboration of the Integral Model of Management of Results in the Socio-Sanitary Attention (MIGRASS); and the creation of context analysis for the measurement of efficiency in public management.

Verónica Cabo Muíños, Universidad Internacional de Andalucía / Universidad Católica Nordestana

Degree in Pharmacy from the Universidad Complutense de Madrid (Spain). Specialty in Clinical Analysis (MIR training) in the Biochemistry Service at the Hospital Virgen de la Salud in Toledo (Spain). Specialist in Management of Assistance Processes with ABQ Methodology and Master in Advanced Clinical Management from the Universidad a Distancia de Madrid (UDIMA). Specialist in Human Reproduction Assisted from the Universidad de Salamanca (Spain). She is Director of Assistance Projects for IHM-Medical Technology.

Carlos de Castro Lozano, Universidad Internacional de Andalucía / IHM-Medical Technology / Universidad a Distancia de Madrid / Universidad de Córdoba

Doctor of Sciences from the University de Córdoba [UCO], Spain. Professor of Systems Engineering of the Computing Department of the UCO, expert in multimedia systems, human computer interaction, usability and Web accessibility, and interactive systems. Director of the Digital Contents Experimentation and Production Center of the UCO (Red.es) and the CRUE (CITEC). Director of the EATCO (Teaching and Learning by Communication Technologies) research group. Scientific director and creator of the products: iFreeTablet, iFreeTV, iFreeSIN, iFreemovil, Siesta, SiestaTV, SiestaCare, SiestaDomo, Wikicourses, and Tu-Learning. Responsible for wikicourses at the REDAuti of the CYTED. Coordinator of the EVA (Virtual Learning Spaces) Network at the Universidad Internacional de Andalucía (Spain). President of the Fundación Red Especial España (FREE). Scientific Director of the Multimedia Production Center for Interactive Television (CPMTI) and of the Center for Multimedia and Animation Innovation (CIMA).

Javier Ramos López, Universidad Rey Juan Carlos, Madrid

Rector at the Universidad Rey Juan Carlos de Madrid [URJC], Spain. Doctor of Telecommunications Engineering from the Universidad Politécnica de Madrid (Spain). Former postdoctoral researcher at Universidad de Purdue (West Lafayette, IN). Ericsson Award for the best doctoral thesis awarded by the Official College of Telecommunications Engineers. Professor in the area of ​​Signal Theory and Communications at the Universidad Carlos III de Madrid (1999-2003). Professor of Signal Theory and Communications at the URJC (2011). Director of the Higher Technical School of Telecommunications Engineering of the URJC (2005-2017). Fellowships at the Universidad de Minnesota (Minneapolis-MN, 2010) and at the Massachusetts Institute of Technology - MIT (Cambridge-MA, 2013). He has four research six-year terms and four five-year teaching periods. His areas of research are signal processing and information and its application to wireless communications and the processing of information on health problems (Big Data & eHealth).

References

Arshad, P., Oxley, H., Watts, S., Davenport, S., & Sermin, N. (2000). Systematic approach to community risk assessment and management. Br J Nurs., 9(4), 210-214.
Barr, V., Robinson, S., Marin-Link, B., Hunderhill, L., Dotts, A., Ravensdale, D., & Salivaras, S. (2003). The expanded chronical care model. Hospital Quaterly, 7(1), 73-82.
Beaglehole, R.B., Epping-Jordan, J.E., Patel, V., Chopra, M., Ebrahim, S., Kidd, M., & Haines, A. (2008). Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. The Lancet, 372(9642), 940-949.
Bengoa, R., Nuño, R. (2008). Curar y cuidar. Innovación en la gestión de enfermedades crónicas: una guía práctica para avanzar. Barcelona, España: Elsevier-Masson.
Bodenheimer, T. & Berry-Millett, R. (2009). Care management of patients with complex health care needs. Princeton, NJ: Robert Wood Johnson Foundation.
Boult, C., Kane, R.L., & Brown, R. (2000). Managed care of chronically ill older people: The US experience. BMJ, 321(7267), 1011-1014.
Boult, C., Kane, R.L., Pacala, J.T., &Wagner, E.H. (1999). Innovative healthcare for chronically ill older persons: Results of a national survey. Am J Managed Care, 5(9), 1162-1172.
Boult, C., Reider, L., Frey, K., Leff, B., Boyd, C.M. ... Scharfstein, D. (2008). Early effects of “Guided Care” on the quality of health care for multimorbid older persons: A cluster-randomized controlled trial. J Gerontol Med Sci., 63A(3), 321-327.
Boult, C., Shadmi, E., Leff, B., Brager, R., Dunbar, L., Wolff, J.L., & Wegener, S. (2007). Guided care for multi-morbid older adults. Gerontologist, 47(5), 697-704.
Busse, R., Blümel, M., Scheller-Kreinsen, D., & Zentner, A. (2009). Managing chronic disease in Europe: The initiative for sustainable healthcare financing in Europe. Retrieved from: http://www.sustainhealthcare.org/navigation/CDM
Cabo-Salvador, J. & Bellmont, M.A. (2014). Sistemas sanitarios y reformas sanitarias: enfoque hacia la calidad. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias (pp. 1-48). Madrid, España: Diaz de Santos.
Cabo-Salvador, J. (2017). El impacto de la u-health, inteligencia artificial, robótica y nanotecnología en la medicina y el derecho. Proceedings XXIV Congreso Nacional de Derecho Sanitario, (pp.1-43). Madrid, España.
Cabo-Salvador, J., Bellmont, M.A., Cabo, J., & Cabo, V. (2014). Ajustes de riesgos y calidad asistencial. Agrupadores (APG, GRD, AP-GRD, IR-GRD, ACG, DxCG, CRG). In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias (pp. 1157-1210). Madrid, España: Diaz de Santos.
Cabo-Salvador, J., Bellmont, M.A., Cabo, J., & Herreros, J. (2010). Estructura organizativa, financiación, gasto, provisión de servicios y desarrollo de los sistemas sanitarios en los países de la Comunidad Económica Europea. In: J. Cabo-Salvador. (Ed.), Gestión sanitaria integral: pública y privada (pp. 85- 133). Madrid, España: Centro de Estudios Financieros
Cabo-Salvador, J., Bellmont, M.A., Cabo, V., Herreros, J., López, M., Sajardo, S., Ramos, J., & Velarde, J. et al. Gestión de la eficiencia y calidad asistencial en las organizaciones sanitarias. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias (pp. 371-409). Madrid, España: Diaz de Santos.
Cabo-Salvador, J., Bellmont, M.A., Herreros, J., & Cabo, J. (2014). Estudios de Evaluación Económica de Nuevas Tecnologías y Terapias Asistenciales con enfoque a la calidad asistencial. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias (pp. 1207-1270). Madrid, España: Diaz de Santos.
Cabo-Salvador, J., Cabo, J., & Iglesias, R. (2010). Sistemas de salud y reformas sanitarias en España, Canadá y Estados Unidos. In: J. Cabo-Salvador (Ed.), Gestión sanitaria integral: pública y privada, (pp. 31- 84). Madrid, España: Centro de Estudios Financieros.
Cabo-Salvador, J., de Castro C, Cabo, V., Ramos, J., & López, M. (2017). El futuro de la IPTV integrada con la inteligencia artificial en la gestión socio sanitaria integrada. In: Proceedings of the 6th Iberoamerican Conference on Disease Management: Applications and Usability for Interactive TV. JAUTI ( pp.115-129).
Cabo-Salvador, J., Herreros, J., Cabo, V., Bellmont, M.A., García, E., &Vilches, M. (2014). Plan estratégico de gestión de las organizaciones sanitarias: gestión clínica y gobierno clínico. In: Reunió d’experts: Innovant en prevenció cardiovascular i eficiencia. Barcelona, España: Price Waterhouse Coopers.
Cabo-Salvador, J., Ramirez Uceda JM, Cabo, V., Ramos, J., & de Castro, C. (2018). Ubiquitous computing and its applications in the disease management in a ubiquitous city. Journal of Computer and Communications,6(3), 19. doi:10.4236/jcc.2018.63002
Cabo-Salvador., J. & Unda, E. (2010). Sistemas de ajuste de riesgos (AP-GRDs, APR-GRDs, IR-GRDs, CRGs, DxCGs): gestión por procesos y benchmarking. In: J. Cabo-Salvador. (Ed.), Gestión sanitaria integral: pública y privada (pp. 453- 512). Madrid, España: Centro de Estudios Financieros.
Clark, C.M Jr., Snyder, J.W., Meek, R.L., Stutz, L.M., & Parkin, C.G. (2001). A systematic approach to risk stratification and intervention within a managed care environment improves diabetes outcomes and patient satisfaction. Diabetes Care, 24(6), 1079-1086.
Coleman, K., Austin, B.T., Brach, C., & Wagner, E.H. (2009). Evidence on the chronic care model in the new millennium. Health Affairs, 28(1), 75-85.
Curtis, L. (comp.). (2012). Unit costs of health and social care 2012. Canterbury, UK: University of Kent.
de Castro, C., Cabo-Salvador, J., Ramírez, J.M., & García, E. (2014). SIESTACARE: inteligencia ambiental aplicada a sistemas e-salud como tecnología de ayuda a enfermos y personas en situaciones de dependencia. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias, (pp. 953- 1008). Madrid, España: Diaz de Santos.
Drennan, V. & Goodman, C. (2004). Nurse-led case management for older people with long-term conditions. Br J Community Nurs., 9(12), 527-533.
Epping-Jordan, J.E., Pruitt, S.D., Bengoa, R., & Wagner, E.H. (2004). Improving the quality of health care for chronic conditions. Quality and Safety in Health Care,13(4), 299-305.
Evercare (n.d). Implementing the Evercare program: Interim report. Retrieved from: http://www.natpact.info/cms/186.php
Fussell, E. (2006). Leaving New Orleans: Social stratification, networks, and hurricane evacuation. Social Science Research Council 2006; June 11. Retrieved from: http://understandingkatrina.ssrc.org/Fussell/
Gilmer, T.P., O'Connor, P.J., Rush, W.A., Crain, A.L., Whitebird, R.R., Hanon, A.M., & Solberg, L.I. (2006). Impact of office systems and improvement strategies on costs of care for adults with diabetes. Diabetes Care, 29(6):1242-1248.
Gravelle, H., Dusheiko, M., Sheaff, R., Sargent, P., Boaden, R., Pickard, S., Parker, S., & Roland, M. (2007). Impact of case management (Evercare) on frail patients: Controlled before and after analysis of quantitative outcome data. BMJ, 334(7583), 31-34.
Gonseth, J., Guallar-Castillón, P., Banegas, J.R., & Rodríguez-Artalejo, F. (2004). The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: A systematic review and meta-analysis of published reports. Eur Heart J., 25(18):1570-1595.
Goodwin, N. & Curry, N. (2008). Methods for predicting risk of emergency hospitalization. In: 8th INIC Annual Conference. Gothenburg; 7th March 2008.
Goodwin, N. & Curry, N. (2008). Methods for predicting risk of emergency hospitalization. In: 8th INIC Annual Conference. Gothenburg.
Health and Social Care Information Centre [HSCIC]. (2015). Personal social services expenditure and unit costs, England, 2014-15: Final release. London, UK: HSCIC.
Hébert, R., Raîche, M., Dubois, M. F., Gueye, N. D. R., Dubuc, N., Tousignant, M., & PRISMA Group. (2009). Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65(1), 107-118.
Herreros, J. & Cabo-Salvador, J. (2014). Calidad y efectividad en las organizaciones sanitarias. sistemas de información, adecuación de recursos y gestión de riesgos. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias, (pp. 345-379). Madrid, España: Diaz de Santos.
Hroscikoski, M.C., Solberg, L.I., Sperl-Hillen, J.M., Harper, P.G., McGrail, M.P., & Crabtree, B.F. (2006). Challenges of change: a qualitative study of chronic care model implementation. Ann Fam Med.,4(4):317-326.
Jhon Hopkins University (2010). The Johns Hopkins ACG® System: Technical Reference Guide version 10.0. Baltimore, MD: Jhon Hopkins University.
Johnston, S. (2009). Cloud Computing [image]. Retrieved from: https://commons.wikimedia.org/wiki/File:Cloud_computing.svg
Kane, R., Keckhafer, G., & Robst, J. (2002). Evaluation of the Evercare demonstration program: Final report to the centers for medicare and medicaid services. Minneapolis, MN: University of Minnesota.
Kane, R.L., Keckhafer, G., Flood, S., Bershadsky, B., & Siadaty, M.S. (2003). The effect of Evercare on hospital use. J Am Geriatr Soc., 51(10), 1427-1434.
Kreindler, S. (2008). Lifting the burden of chronic disease. Winnipeg , MB: Winnipeg Regional Health Authority.
López, M., de la Torre, I., Herreros, J., Cabo-Salvador, J. (2014). Mejora de la Calidad Asistencial mediante la Telemedicina y la Teleasistencia. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias, (pp. 933-952). Madrid, España: Diaz de Santos.
MacAdam, M. (2008). Frameworks of integrated care for the elderly: A systematic review. Toronto, ON: Canadian Policy Research Networks.
MacColl Institute for Health Care Innovation. (2013). Chronic care model [image]. Retrieved from: http://www.maccollcenter.org/resources/chronic-care-model
Medicare Payment Advisory Commission [MedPAC]. Report to Congress: Promoting greater efficiency in Medicare. Washington, DC: MedPAC.
Morgan, M.W., Zamora, N.E., & Hindmarsh, M.F. (2007). An inconvenient truth: A sustainable healthcare system requires chronic disease prevention and management transformation. Healthcare Papers,7(4), 6-23.
National Public Health Service for Wales. (2006). International overview of the evidence on effective service models in chronic disease management. Cardiff, Wales: Welsh Assembly Government.
Nolte, E. & McKee, M. (Eds). (2008). Caring for people with chronic conditions: A health system perspective. Maidenhead, UK: Open University Press.
Norris, S.L., Nichols, P.J., Caspersen, C.J., Glasgow, R.E., Engelgau, M.M., ... & McCulloch, D. (2002). The effectiveness of disease and case management for people with diabetes: A systematic review. Am J Prev Med.,22(4 Suppl), 15-38.
Observatorio de Prácticas Innovadoras para el Manejo de Enfermedades Complejas [OPIMEC]. (2018).Glosario sobre enfermedades crónicas complejas. Retrieved from: http://www.opimec.org/glosario/
Oeseburg, B., Wynia, K., Middel, B., & Reijneveld, S.A. (2009). Effects of case management for frail older people or those with chronic illness: a systematic review. Nurs Res., 58(3), 201-210.
Ollero. M. (Coord.). (2002). Atención al paciente pluripatológico: Proceso asistencial integrado. Sevilla, España: Consejería de Salud; 2002.
Organización de las Naciones Unidas [ONU]. (2017). Envejecimiento. Retrieved from: http://www.un.org/es/sections/issues-depth/ageing/index.html
Organization for Economic Co-operation and Development [OECD]. (2017). Health at a glance 2017: OECD indicators. Paris, France: OECD
Ouwens, M., Wollersheim, H., Hermens, R., Hulscher, M., & Grol, R. (2005). Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care, 17(2):141-146.
Ovretveit, J. & Staines, A. (2007). Sustained improvement? Findings from an independent case study of the Jönköping quality program. Qual Manag Health Care,16(1), 68-83.
Parchman, M.L., Zeber, J.E., Romero, R.R., & Pugh, J.A. (2007). Risk of coronary artery disease in type 2 diabetes and the delivery of care consistent with the chronic care model in primary care settings: A STARNet study. Med Care, 45(12), 1129-1134.
Parchman, M. & Kaissi, A.A. (2009). Are elements of the chronic care model associated with cardiovascular risk factor control in type 2 diabetes? Jt Comm J Qual Patient Saf., 35(3), 133-138.
Pearson, M.L., Wu, S., Schaefer, J., Bonomi, A.E., Shortell, S.M., ... & Keeler, E.B.(2005). Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res., 40(4), 978-996.
Ramos, J., Soguero, C., Mora, I., Rojo, J.L., & Cabo-Salvador. J. (2014). M-Health y su impacto en la calidad asistencial. In: J. Cabo-Salvador. (Ed.), Gestión de la calidad en las organizaciones sanitarias, (pp. 1009-1052). Madrid, España: Diaz de Santos.
Ramsey, F., Ussery-Hall, A., Garcia, D., McDonald, G., Easton, A., Kambon, M., ... & Vigeant, J. (2008). Prevalence of selected risk behaviors and chronic diseases--Behavioral Risk Factor Surveillance System (BRFSS), 39 steps communities, United States, 2005. MMWR Surveill Summ, 57(11), 1-20.
Real Decreto Ley 16/2012. (2012, abril 22). Boletín Oficial del Estado, Núm. 98 (Sec. I. p. 31278). Madrid, España.
Rosen, R. & Ham, C. (2008). Integrated care: Lessons from evidence and experience. Birmingham, UK: Nuffield Trust.
Russell, G., Thille, P., Hogg, W., & Lemelin, J. (2008). Beyond fighting fires and chasing tails? Chronic illness care plans in Ontario, Canada. Ann Fam Med.,;6(2), 146-153.
Sevick, M.A., Trauth, J.M., Ling, B.S., Anderson, R.T., Piatt, G.A., Kilbourne, A.M., & Goodman, R.M. (2007). Patients with complex chronic diseases: perspectives on supporting self-management. J Gen Intern Med., 22 (suppl 3), 438-444.
Sheaff, R., Boaden, R., Sargent, P., Pickard, S., Gravelle, H., Parker, S., & Roland, M. (2009). Management for frail elderly people: A qualitative study. J Health Serv Res Policy.,14(2), 88-95.
Shojania, K.G., Ranji, S.R., McDonald, K.M., Grimshaw, J.M., Sundaram, V., Rushakoff, R.J., & Owens, D.K. (2006). Effects of quality improvement strategies for type 2 diabetes on glycemic control: A meta-regression analysis. Journal of the American Medical Association, 296(4), 427-440.
Singh, D. (2005). Transforming chronic care: evidence about improving care for people with long-term conditions. Birmingham, UK: University of Birmingham.
Sperl-Hillen, JM. (2004). Do all components of the chronic care model contribute equally to quality improvement? Joint Commission journal on quality and safety, 30(6), 303-309.
Sylvia, M.L., Shadmi, E., Hsiao, C.J., Boyd, C.M., Schuster, A.B., & Boult, C. (2006). Clinical features of high-risk older persons identified by predictive modeling. Dis Manag., 9(1), 56-62.
Sylvia, M., Griswold, M., Dunbar, L., Boyd, C.M., Park, M., & Boult, C. (2008). Guided care: Cost and utilization outcomes in a pilot study. Dis Manag., 11(1), 29-36.
Tinetti, M.E., Bogardus, S.TJr., & Agostini, J.V. (2004). Potential pitfalls of specific disease guidelines for patients with multiple conditions. N Engl J Med., 351(27):2870-2874.
Tracy, C.S., Dantas, G.C., & Moineddin, R. (2003). The nexus of evidence, context, and patient preferences in primary care: postal survey of Canadian family physicians. BMC Fam Pract., 4(13). doi: 10.1186/1471-2296-4-13.
Vickers, A.J., Kramer, B.S., & Baker, S.G. (2006). Selecting patients for randomized trials: a systematic approach based on risk group. Trials, 7(1), 30.
Wagner, E.H. (1998). Chronic disease management: what will it take to improve care for chronic illness? Effective Clin Practice,1(1), 2-4.
Wagner, E.H., Austin, B.T., & Von-Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly,74(4), 511-544.
Wagner, E.H., Davis, C., Schaefer, J., Von-Korff, M., & Austin, B. (1999). A survey of leading chronic disease management programs: are they consistent with the literature? Managed Care Quart,7(3), 56-66.
Wagner, E.H., Sandhu, N., Newton, K.M., McCulloch, D.K., Ramsey, S.D., & Grothaus, L.C . (2001). Effect of improved glycemic control on health care costs and utilization. JAMA, 285(2), 182-189.
Weiss, K.B. (2007). Managing complexity in chronic care: An overview of the VA state-of-the-art (SOTA) conference. J Gen Intern Med.,22 (Suppl 3), 374-378.
Wolff, J.L., Rand-Giovannetti, E., Palmer, S., Wegener, S., Reider, L., Frey, K., & Boult, C. (2009), Caregiving and chronic care: The guided care program for families and friends. J Gerontol Med Sci., 64A(7), 785-791.
World Health Organization [WHO]. (2002). Innovative care for chronic conditions: building blocks for action [Global report WHO/NMC/CCH]. Geneva, Switzerland: WHO.
Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell, D. & Hasan, I. (3006). A systematic review of chronic disease management. Canberra, Australia: Australian Primary Health Care Research Institute.
Published
2018-03-06
Section
Discussion papers