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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Demographic changes (particularly as a result of increased life expectancy), growing specialization (induced by the rapid growth in knowledge) and the threats to the sustainability of the healthcare system make internal medicine increasingly necessary for spearheading new organizational models that better adapt to these changes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Internal medicine is a versatile, multipotent and efficient specialty that, in Portugal and Spain, maintains its holistic capacity, with similar models for internal medicine for the 2 countries. In both health systems, internal medicine constitutes the basis of hospital medicine, establishing itself as a global and inclusive specialty, with an essential leadership role in multidisciplinary areas and in the care of acute, chronic and complex patients with multimorbidity, in the most prevalent clinical conditions and in systemic and rare diseases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the Azores on the 29<span class="elsevierStyleSup">th</span> of April 2018, the Portuguese and Spanish Societies of Internal Medicine agreed to develop the present declaration, which reaffirms the importance of internal medicine for the future of health systems and manifests:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Their commitment to creating high-value practical training that contributes to the sustainability of the health system.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Their commitment to preserving the specialty's global and cohesive nature, promoting the creation of areas of competence and not that of new specialties.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">The need to change the current hospital model and promote new organizational models based on multipurpose departments governed by internists. These models should include differentiated, multidisciplinary and multiprofession units.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0035" class="elsevierStylePara elsevierViewall">The importance of reinforcing the need for leadership by the internists in numerous areas of healthcare activity: hospital emergency departments, intermediate care, oncologic and nononcologic palliative care, continuous care and long-term care.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0040" class="elsevierStylePara elsevierViewall">The need to extend hospital programs for co-managing surgical patients, led by internists.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0045" class="elsevierStylePara elsevierViewall">The need to promote the creation and development of outpatient hospital medicine units (outpatient centers, rapid diagnostic units and home hospitalization) that ensure alternatives to hospitalization for specific populations.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0050" class="elsevierStylePara elsevierViewall">The affirmation of the importance of the internist in the integration of care and in the management of chronic diseases in coordination with primary care and other care levels, as well as with social services. It is urgent that we start to consider health and social care as a whole, due to the increasing difficulty of separating health problems from social problems.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0055" class="elsevierStylePara elsevierViewall">By recognizing internal medicine's capacity to perform diagnostic techniques and its autonomy for treating diseases within its spectrum of intervention, any restriction on its ability to prescribe is rejected.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0060" class="elsevierStylePara elsevierViewall">The importance of internal medicine for integrating teams for preparing, implementing and monitoring national clinical practice guidelines and the importance of internal medicine's participation in the organization of health programs and reforms.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0065" class="elsevierStylePara elsevierViewall">The affirmation of internal medicine's importance in teaching undergraduate and graduate courses in universities and its importance in scientific research.</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">In conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">This document affirms the role that internal medicine seeks in constructing an effective, inclusive, efficient and sustainable health system and alerts us to the importance of strong political support for this set of strategies to enable its effective implementation.</p></span></span>"
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