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CRF: chronic renal failure; ESA: erythropoiesis-stimulating agents; Fe: iron; Ft: ferritin; IA: inflammatory anemia; IDA: iron-deficiency anemia; IRIDA: iron-refractory iron-deficiency anemia; IVFe: intravenous iron; TSAT: transferrin saturation index; WHO: World Health Organization.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. García Erce, A. Altés, M. López Rubio, Á.F. Remacha" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "García Erce" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Altés" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "López Rubio" ] 3 => array:2 [ "nombre" => "Á.F." 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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "28" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es el hierro oral siempre la mejor opción?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Grau Amorós" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Grau Amorós" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519302954" "doi" => "10.1016/j.rce.2019.11.002" "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/S0014256519302954?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300023?idApp=WRCEE" "url" => "/22548874/0000022000000001/v1_202002130124/S2254887420300023/v1_202002130124/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>" "titulo" => "Improving the care of people with chronic conditions in Spain. Common Position Statement of the Spanish Society of Internal Medicine and the Spanish Society of Family and Community Medicine" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "29" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mejoras en la atención a personas con enfermedades crónicas en España. Declaración de posición común de la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina Familiar y Comunitaria" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Demographic and epidemiological changes are resulting in a marked increase in the prevalence of elderly patients with multimorbidity, frailty and dependence. In 2011, a group of scientific societies and healthcare administrations developed the Declaration of Seville on the organization of healthcare for chronically ill patients. Eight years later, the care for chronicity remains a priority topic that has not been properly addressed in the healthcare system. The Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Family and Community Medicine (semFYC) therefore met in Merida (Spain) on the 8<span class="elsevierStyleSup">th</span> of March 2019 to reach the following considerations:</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is an urgent need to reorient our current healthcare model, which is focused on the care of acute disease, towards a new model of care for chronically ill patients. We need an individual-focused approach, using a holistic perspective, based on comprehensive and coordinated care, avoiding the fragmentation of care by numerous specialists.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The healthcare model for addressing chronicity should be centered on the patient and their environment, respecting their preferences, needs and values, and should ensure equity in the access to resources, prioritizing high-value practices and ensuring an appropriate quality of life.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Care for chronically ill patients with multiple diseases should be implemented in a longitudinal, integrated and coordinated manner among the various healthcare levels, requiring interdisciplinary efforts and continuity of care. Primary care practitioners, physicians and nurses are primarily responsible for the care of chronically ill patients. Internal medicine specialists should coordinate the care of these patients in the hospital.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Progress needs to be made towards a patient-centered model based on shared decision making, where each individual has a personal, unique and individualized plan for managing their diseases. This plan should incorporate their personal preferences, degree of understanding of their disease, their healthcare and social needs, diagnostic strategies, therapeutic objectives, the limits of care and the reference health professionals. The classical paternalistic healthcare model should evolve towards a model that incorporates shared decision making.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Campaigns and interventions that promote prediseases and that encourage overdiagnosis and overtreatment should be avoided, as should the inappropriate use of healthcare resources. Health promotion and disease prevention activities should be made a priority, with populational and individual strategies that are assessable and cost effective.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The gender perspective should be an integral part of the educational and health promotion programs in 21<span class="elsevierStyleSup">st</span> century medicine. Healthcare systems should ensure that women receive coverage for their healthcare needs, allowing them to reconcile their societal, biological and occupational functions.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Home care should play a key role in caring for chronically ill patients in situations of frailty, dependence and end of life. We need to develop alternatives to conventional hospitalization, reinforcing the multidisciplinary primary care teams, with special relevance for family and community nursing.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We need to promote the development of rapid diagnosis units, high-resolution consultations, virtual interconsultations, outpatient centers, continuity-of-care units and home hospitalization units as support units for primary care. These entities should be complemented by a network of social services, healthcare centers and residences that ensure care fitted to the needs of patients and their caregivers.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The development of information technology and communication represents a major opportunity for improving the health results of chronically ill patients. Telemedicine should be a fundamental tool for the prompt control of exacerbations and for preventing hospitalizations, as well as for involving patients in their self care and improving therapeutic compliance.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is essential that we reinforce the integral and holistic vision of care for chronicity in the undergraduate and graduate education programs in universities, led by family and internal medicine professionals.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Concept and design of the manuscript. SEMI, SEMFYC</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Data collection. SEMI, SEMFYC</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0070" class="elsevierStylePara elsevierViewall">Data analysis and interpretation. SEMI, SEMFYC</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Drafting, review and approval of the submitted manuscript. SEMI, SEMFYC</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">Spanish Society of Internal Medicine (SEMI) and Spanish Society of Family and Community Medicine (SEMFYC)</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Grau Amorós J. ¿Es el hierro oral siempre la mejor opción?. Rev Clin Esp. 2020. https://doi.org/10.1016/j.rce.2019.11.010.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000001/v1_202002130124/S2254887420300011/v1_202002130124/en/main.assets" "Apartado" => array:4 [ "identificador" => "72714" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000001/v1_202002130124/S2254887420300011/v1_202002130124/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300011?idApp=WRCEE" ]
