The ETXEAN ONDO pilot project is an integrated care approach which was implemented in the Basque Country. It aimed to provide adequate support and care for elderly people living at home or in nursing homes, for family members and care professionals.
The key elements of this model were the provision of a single entry point, the adoption of a case management methodology and an individualised service plan that respected patients' dignity, rights, interests and preferences. The initiative was designed to provide highly patient-centred care to the elderly, including self-management strategies and tools for health prevention and promotion. The process started by profiling patients according to their risk factors in order to identify preventive measures adapted to their cases and empower them to adopt a much more active role in managing their illness. This approach was expected to reduce patients' demands on the health service while improving their quality of life and that of their carers, contributing to the sustainability of the system.
LUPIANEZ - VILLANUEVA Francisco;
THEBEN Alexandra;
ABADIE Fabienne;
CODAGNONE Cristiano;
2015-02-02
Publications Office of the European Union
JRC94486
978-92-79-45426-4,
1831-9424,
EUR 27103,
OP LF-NA-27103-EN-N,
https://publications.jrc.ec.europa.eu/repository/handle/JRC94486,
10.2791/180635,
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