Capítulo 4. Un sistema de salud integrado y centrado en los usuarios. La integración asistencial, ¿Doctor Jekyll o Mr. Hyde?
Integración y fronteras entre la atención sanitaria y social. Informe SESPAS 2008
Integration and boundaries between health and social care
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Un sistema de salud integrado y centrado en los usuarios. La integración asistencial, ¿Doctor Jekyll o Mr. Hyde?</span>" "titulo" => "La gestión de casos y de enfermedades, y la mejora de la coordinación de la atención sanitaria en España. Informe SESPAS 2008" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "163" "paginaFinal" => "168" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Case and disease management and improved integration of healthcare services in Spain" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Gérvas" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Gérvas" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911108760886?idApp=WGSE" "url" => "/02139111/00000022000000S1/v1_201301221349/S0213911108760886/v1_201301221349/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0213911108760862" "issn" => "02139111" "doi" => "10.1016/S0213-9111(08)76086-2" "estado" => "S300" "fechaPublicacion" => "2008-04-01" "aid" => "76086" "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2008;22 Supl 1:143-55" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4026 "formatos" => array:3 [ "EPUB" => 168 "HTML" => 2005 "PDF" => 1853 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Capítulo 3. Prioridades generales y prestaciones individuales</span>" "titulo" => "Posibilidades y limitaciones de la gestión por resultados de salud, el pago por objetivos y el redireccionamiento de los incentivos. 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Un sistema de salud integrado y centrado en los usuarios. La integración asistencial, ¿Doctor Jekyll o Mr. Hyde?</span>" "titulo" => "Integración y fronteras entre la atención sanitaria y social. Informe SESPAS 2008" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "156" "paginaFinal" => "162" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Victoria Zunzunegui Pastor, Pablo Lázaro, de Mercado" "autores" => array:3 [ 0 => array:3 [ "nombre" => "María Victoria" "apellidos" => "Zunzunegui Pastor" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Pablo" "apellidos" => "Lázaro" ] 2 => array:3 [ "nombre" => "de" "apellidos" => "Mercado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Université de Montreal, Québec, Canadá" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: María Victoria Zunzunegui Pastor. Técnicas Avanzadas de Investigación en Servicios de Salud." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Integration and boundaries between health and social care" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13662" "palabras" => array:4 [ 0 => "Atención sociosanitaria" 1 => "Dependencia" 2 => "Salud mental" 3 => "Integración de servicios" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13661" "palabras" => array:4 [ 0 => "Sociomedical care" 1 => "Dependency" 2 => "Mental health" 3 => "Services integration" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">En este trabajo se examinan las posibilidades de integración de los servicios sociales y sanitarios en el contexto español. Nos referiremos a la recientemente promulgada Ley de Promoción de la autonomía personal y de atención a las personas en situación de dependencia y al Plan de Atención a la Salud Mental como ilustraciones de políticas que necesitan para su desarrollo un alto grado de integración en los niveles de financiación, organización y atención clínica. Se plantean preguntas como: ¿qué sabemos sobre la efectividad de la integración de los servicios sanitarios con los servicios sociales?, ¿quiénes deben ser objeto de integración de servicios y cuáles son las estructuras de apoyo para servicios integrados centrados en las necesidades de los usuarios?, ¿quién debe estar al mando de los servicios integrados?</p><p class="elsevierStyleSimplePara elsevierViewall">Se definen las cinco leyes sobre la integración de servicios propuestas por Leutz y se revisan varias experiencias internacionales. Se concluye que estamos en un momento favorable para transformar los servicios sanitarios y sociales en la atención a la dependencia y a los problemas de salud mental hacia una mayor integración. Se recomienda un sistema de servicios integrados para personas con dependencia moderada y grave, descentralizado al nivel de zona básica de salud y servicios sociales, con un único presupuesto calculado por estimación de gasto per cápita, donde el equipo interdisciplinario y el gestor de caso (profesionales de enfermería o trabajadores sociales) tengan la responsabilidad clínica y financiera de los cuidados prestados a los usuarios.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">We examine the opportunities to establish integrated services in Spain. The new law on services for disabled people approved by the Spanish Parliament in December 2006 and the Mental Health Plan of the Spanish Ministry of Health are used to illustrate policies that will require a high degree of integration among organizational, financial and clinical levels. In this context, some of the following questions arise: what do we know about the effectiveness of the integration of health and social services? Who should be the targets of integration and what are the structures needed for patient-centered services? Who should be responsible for and manage these services?</p><p class="elsevierStyleSimplePara elsevierViewall">An outline of Leutz's five criteria for integration is reviewed and the results from international experiences are discussed. We conclude that Spain is at a crossroads for the integration of services for disabled people and people with mental health problems. We recommend that a system of integrated services be organized for people with moderate or severe disability. This system should be decentralized at the levels of local health and social services, with a single budget estimated on a capitation basis. Clinical and financial responsibility should be shared between the interdisciplinary team and the case manager (nursing or social work professionals).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "BOE. Ley de Cohesión y Calidad. Boletín Oficial del Estado 128 de 29/05/2003. Sección 1. Pág. 20567-88." ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "BOE. 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