Primary health care, the backbone of social and health care

The socio-health coordination it brings with it a series of challenges and problems whose approach is complex. To find answers to these challenges, Medical writingin cooperation with the Spanish Confederation of Persons with Physical and Organic Disabilities (Cocemfe), on his set he gathers four people from the field who, each from their field of activity, give a special perspective on the approach to the problem.

The first question posed to experts is whether there is a need for stricter regulation in order to improve the development of social and health coordination. Raul de Simon Gutierrez, secretary of the Autonomous Board of Directors of the Spanish Society of Primary Care Physicians (Semergen) recognized that the difficulties usually encountered in this coordination are not at the regulatory level, since this regulation “already exists”. “What is needed is yes regulatory foundations are developed at the service portfolio levelboth national and regional”, assured the representative of Semergen.

Elena Antelothe director of Cocemfe, agrees that the problem is not in the lack of legal regulations and pointed out that it is crucial to “keep in mind that one must change the model of attention towards peopleFor this, he appealed for coordination, not only between the social and health sectors, but also with others involved. “If we are talking, for example, about children with developmental disabilities, coordination with the educational field is also necessary,” he said. Eduardo Díaz, a sociologist specializing in disability and addiction, stated that what is needed is “a working culture of better coordination between the different levels”.

Full discussion: “Challenges of social and health coordination”

Can this lack of coordination between systems be attributed to a lack of political will? The four participants agree that there is no lack of will, but difficulties on the way. “There is a lack of motivation; it’s so hard that it’s a bit intimidating to get into on all levelspoliticians, but also us,” Antelo pointed out, and Díaz added that the problem could be in the “complexity of health and organizational structures, where competences can sometimes overlap.” He also reminded that “sometimes it is not clear who should treat the patient or if it is a social or health problem”.

https://www.youtube.com/watch?v=W14jqvx04 Okay Luis Barriga talks about the need to “reorganize the system” around patient priorities.

Luis Barriga, director general of the Institute for the Elderly and Social Services (Imserso), is clear yes the solution does not go through the grouping of both sectors under the same ministry. “It was never a guarantee of better coordination, there are common challenges, but that does not mean that it will work better. The solution lies in changing the mentality and changing the model,” he assured.

Eduardo Díaz commented that “giving value to the services of social systems” would be a way to improve and change the model, “center it on the person in an integrated way” and encourage coordination among all actors.

Care for the elderly

When asked whether subjects covering socio-health should be included in degrees such as medicine or nursing, the four experts agree that it is not necessary, although Raúl de Simón Gutiérrez pointed out that it would be interesting to talk more about curricular visions of illness. “Sometimes We talk more about diseases than about the sick and emphasis should be placed on the biopsychosocial vision of patients,” he assures. He also believes that there are areas such as geriatrics and care for the elderly “that are not sufficiently represented in the study”.

Elena Antelo argues that it is important to see nursing homes as “homes” and not as health centers.

One of the most expected and relevant developments in the social sphere was the approval of the new disability assessment scale, one of the strictest requirements in the sector and which has not been changed since 1999. “We did not comply with the regulations required by the World Health Organization (WHO); we followed the old classification and for that reason alone it is a fundamental advance,” the Cocemfe director assured. Among the advances, the director of Imsers points out that there has been a paradigm shift: “Now the assessment of disability is not only based on pathologies, that ‘pathologizing’ approach to disability, but on how the environment supports what the person also has,” he explained. In this way, he commented that even if two people have the same pathology, it can match them different degrees of disability depending on how much support they have or notor technical aids available to them.

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The pathological approach to the disease is ignored and all variables are taken into account to determine the degree of disability.

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The impact of Covid-19 on social-health coordination

Raúl de Simón Gutiérrez talks about the importance of talking more about the sick and less about diseases.

The second block dealt with the “effects” that the pandemic as a consequence of Covid-19 had on social-health coordination. Simón de Gutiérrez, as a primary care physician, explained it more focus is placed on home care. “This is very important because the health care model for chronic diseases is not in hospitals, or even in nursing homes, but in home care, because most patients want to be at home,” he assures.

For his part, Luis Barriga commented that although there are centers, such as homes for the elderly, which are called socio-sanitary, “they do not have enough devices to take care of certain situations”. “The pandemic has given us many clues about where we should go and how it is a model with which people can really care in their environments, in all their needs,” she explained. Elena Antelo reminded that senior centers “are homes” for the people who live in them, not health centers. “Those people, for whatever reason, live there and it’s their home, you can’t think of this as a hospital,” he said.

Experts discuss how Covid-19 has changed social and health care priorities.

“Cooking” of socio-sanitary coordination in elementary school

The last block of discussion focused on the application of this coordination to specific realities, especially in the field of primary health care. “If the place can be vertebral space of all this coordination we’re talking about, it has to be First attention“, assured Raúl de Simón Gutiérrez. Even so, he commented that “the lack of resources” may be what prevents this application, but, even so, “in a theoretical concept” it would be the perfect place “to cook social and health care “.

Eduardo Díaz talks about the disadvantages of grouping social and health care in the same Ministry.

He also highlighted the character of the family medicine doctor who maintains a continuous relationship with the patient, “through all the patient’s vital stages”, which makes him the perfect agent for that entourage of people. “The only thing that we sometimes lack is preparation in the most social aspects of the disease, which is why I would highlight the number of social workers who are in health centers,” he pointed out.

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“Lack of preparation for the most social aspects of the disease”

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On the other hand, Luis Barriga highlighted the space of what he calls “public pharmacies”. “For example, I live in a very small town and the pharmacy is essential because a lot of information or notifications come through that way,” he commented. He also talks about how pharmacists know the specific situations of patients and are another point of support.

Finally, Elena Antelo recalled the importance of implementing the idea of ​​socio-sanitary coordination achieving prevention and improvement of the system in favor of the quality of life. “There are people with disabilities or chronic diseases who, although the systems are coordinated, cannot be from one place to another. What they need is to live a quality life, and it is important to include that in the equation,” he said. concluded the director of Cofemce.

The four experts agree that better application of the existing regulation is needed, not its amendment.