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Švab I, Cerovečki V. Person-centred care, a core concept of family medicine. Eur J Gen Pract 2024; 30:2393860. [PMID: 39190294 DOI: 10.1080/13814788.2024.2393860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/09/2024] [Accepted: 12/18/2024] [Indexed: 08/28/2024] Open
Affiliation(s)
- Igor Švab
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Venija Cerovečki
- School of Medicine, Department of Family Medicine, University of Zagreb, Zagreb, Croatia
- Health Center Zagreb-Centar, Zagreb, Croatia
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2
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Wellman CD, Franks AM, Stickler M, Rollyson W, Korkmaz A, Christiansen MQ, Petrany SM. Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions. Fam Pract 2024; 41:326-332. [PMID: 36730038 DOI: 10.1093/fampra/cmad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions. METHODS Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission. RESULTS Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73-22.75) and coronary artery disease (OR 6.71; 95% CI 1.84-24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96-26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09-0.50), answered calls (OR 0.16; CI 0.07-0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07-0.54), and visit arrival (OR 0.39; 95% CI 0.17-0.91) independently associated with decreased readmission rate. Patient-specific (hypertension-OR 3.65; CI 1.03-12.87) and admission-specific (nephrologic system-OR 3.22; CI 1.02-10.14) factors associated with readmissions which differed from the initial analysis. CONCLUSIONS Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources.
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Affiliation(s)
- Courtney D Wellman
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Adam M Franks
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Morgan Stickler
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - William Rollyson
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Alperen Korkmaz
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Matthew Q Christiansen
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Stephen M Petrany
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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Engmann ST. Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students. Afr J Prim Health Care Fam Med 2024; 16:e1-e3. [PMID: 38426782 PMCID: PMC10913169 DOI: 10.4102/phcfm.v16i1.4278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024] Open
Abstract
Teaching family medicine to medical students is primarily intended to aid in their understanding of the distinctive and significant role that the speciality performs within the healthcare system. Improving medical students' comprehension of family medicine may have an impact on their decision to pursue family medicine as a speciality. It is important to use innovative evidence-based teaching and learning strategies and ensure that medical students receive extra learning opportunities in family medicine. This is a short report highlighting the use of audio-visual aids and case studies to enhance the understanding of family medicine principles among undergraduate medical students attending a private university in Ghana.Contribution: This short report offers family medicine teachers and educators at the undergraduate level an example of how to apply audio-visual aids and case studies to enhance the understanding of family medicine principles among students. The report contributes to the growth of family medicine as a speciality within the African context.
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Affiliation(s)
- Stephen T Engmann
- Family Medicine Unit, Manna Mission Hospital, Accra, Ghana Family Health Medical School, Family Health University College, Accra, Ghana.
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Ohta R, Sano C. Challenges Faced by Medical Trainees in Outpatient Management Education in Acute Care Hospitals: A Thematic Analysis. Cureus 2024; 16:e53800. [PMID: 38465019 PMCID: PMC10924075 DOI: 10.7759/cureus.53800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction As societies age globally, medical education faces the challenge of adapting to the evolving healthcare needs of an aging population. This study focuses on the education of medical residents in outpatient departments in Japan, a country with a rapidly aging society. The research aims to understand the perceptions and challenges medical residents face in outpatient management, highlighting the areas for potential improvement in their educational framework. Method This study involved first-year medical residents at Fuchu Hospital in Osaka, using thematic analysis based on relativist ontology and constructivist epistemology. Data were collected through field notes and reflection sheets, documenting residents' interactions with patients, learning difficulties, and personal reflections. Semi-structured interviews were conducted to gain profound insights into their experiences and views on outpatient management education. Results Three main themes emerged from the analysis: The experience of continuity of care, the view regarding comprehensive management, and the gap between purposes and learning content. Residents expressed concerns about the limited opportunities for continuous patient care, leading to challenges in managing chronic diseases effectively. The focus on organ-specific specialties in acute care hospitals resulted in a fragmented understanding of patient care, particularly for elderly patients with multimorbidity. Furthermore, the study identified a discrepancy between the educational goals of outpatient management and the actual content delivered, highlighting the need for more observational experiences and practical guidance in outpatient settings. Conclusion The findings suggest a pressing need for a more structured, comprehensive, and personalized approach to outpatient management education for medical residents. As aging populations continue to grow, it is vital to equip medical professionals with the skills and knowledge to manage a wide range of patient conditions effectively. Improving the educational framework in outpatient departments can enhance patient care quality and prepare medical residents to meet the challenges of an aging society. This study contributes valuable insights into improving medical education in outpatient settings, particularly in aging societies like Japan.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, JPN
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Ohta R, Sano C. Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis. Cureus 2023; 15:e50874. [PMID: 38249198 PMCID: PMC10799234 DOI: 10.7759/cureus.50874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The dynamism inherent in general medicine, particularly since its recognition as a distinct specialty in 2019, necessitates constant revision and refinement of the curriculum. As general medicine programs proliferate throughout Japan, understanding the revision processes, especially concerning the pivotal concept of lateral integrations, becomes critical. Lateral integrations, which pertain to the interconnectedness between learning contents and contexts, ensure a cohesive learning experience for medical students. In this study, we sought to explore the intricacies and experiences of revising these integrations within the general medicine curriculum. Methods A qualitative thematic analysis rooted in relativist ontology and constructivist epistemology was conducted. The research was carried out at the Unnan City Hospital, Shimane Prefecture, focusing on trainees transitioning between diverse medical settings. Semi-structured interviews were employed to gauge perceptions regarding these transitions, and thematic analysis was used to interpret the data. Reflexivity was ensured by the diverse expertise of the research team, with rigorous discussions to mitigate biases. Results The following four themes emerged from the analysis: (1) confusion due to the transition from acute to chronic clinical settings, with trainees feeling overwhelmed and resistant to focus solely on chronic care; (2) monotony due to the loss of some clinical experiences, indicating challenges in maintaining motivation after transitioning to clinics; (3) disconnection between learning contexts, where participants desired stronger links to their primary training hospitals; and (4) anxiety as community leaders, highlighting the need for instilling leadership skills and a deeper understanding of diverse community healthcare professions. Conclusion This study shed light on the tangible challenges faced by general medicine trainees during transitions between different learning environments. These insights are valuable for educators in refining curriculum structures, ensuring smooth transitions, and enhancing lateral integrations. Addressing these challenges will bolster the quality and relevance of general medicine education in Japan, fostering the creation of adaptable, well-rounded physicians who are attuned to the multifaceted needs of their communities.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Ohta R, Nishikura N, Sano C. What Do Medical Students Learn about Community Care from Discussions with General Physicians? A Thematic Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1855. [PMID: 37893573 PMCID: PMC10607926 DOI: 10.3390/medicina59101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Sustainable healthcare is fundamentally rooted in community medicine education. The COVID-19 pandemic disrupted global advancement in integrating traditional teaching and experiential learning. Additionally, an alarming decline in interest in community care has been observed among senior medical students. Here, we examined the perspectives on community care obtained from conversations with general physicians in rural medical universities. Materials and Methods: Using a constructivist lens, a qualitative methodology was employed to examine the perceptions of second-year medical students from Shimane University Medical School regarding community care, informed by dialogues with general physicians. We conducted a thematic analysis at Shimane University, Japan, an area known for its aging population. In 2023, 116 second-year students participated, none of whom had prior formal training in community care. The study was structured into three phases: (1) Pre-education: Students wrote essays about their initial understanding of community care, its advantages, disadvantages, and potential improvements; (2) Dialogue: Grouped by topic, students engaged in discussions that culminated in a comprehensive session with general physicians; and (3) Reflection: After discussions, students wrote essays reflecting any shift in their views on community care. A thematic analysis of essays from the pre-education and reflection phases provided a comparative perspective on the students' understanding. Results: Five dominant themes emerged from the thematic analysis: (1) Re-evaluating community care: Recognizing diversity and addressing societal challenges; (2) Interdisciplinary collaboration: Promoting shared roles and teamwork; (3) Learning and practice: Emphasizing hands-on experience and self-reflection; (4) Technological influence: The mutual relationship between community care and technological advancements; and (5) Challenges and resolutions: Identifying problems and crafting solutions. Conclusions: This study sheds light on the evolution of medical students' views on community care and underscores the importance of continuous adaptation in medical education programs.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan;
| | - Nozomi Nishikura
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Ohta R, Sano C. Case Report-Driven Medical Education in Rural Family Medicine Education: A Thematic Analysis. Healthcare (Basel) 2023; 11:2270. [PMID: 37628468 PMCID: PMC10454442 DOI: 10.3390/healthcare11162270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Case-based education (CBE) is a teaching method in which learners work on real-life cases to learn and apply concepts and skills they have been taught. Case report-driven medical education using the CBE framework can effectively facilitate student and resident learning, and entice them to become involved in actual clinical practice. Specific case report-driven medical education methods and learning outcomes are not clarified. This study aimed to clarify the specific learning processes and outcomes of case report-driven medical education in rural community-based medical education. Using a qualitative design based on a thematic analysis approach, data were collected through semi-structured interviews. The study participants were medical students and residents in training at a rural Japanese community hospital. Fifty-one case reports were completed and published in Cureus from April 2021 to March 2023. Participants learned about various difficulties related to volatility, uncertainty, complexity, and ambiguity (VUCA) in the medical care of various older patients, which increased their interest in family medicine. They appreciated the importance of case reports in academic careers and how their responsibilities as researchers increase with collaboration. Case report-driven medical education in community hospitals can drive medical students' and junior residents' learning regarding family medicine in the VUCA world.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Devillers L, Friesse S, Caranta M, Tarazona V, Bourrion B, Saint-Lary O. General practice undergraduate and vocational training: ambulatory teaching and trainers' curriculum and remuneration - a cross-sectional study among 30 member countries of WONCA Europe. BMC MEDICAL EDUCATION 2023; 23:439. [PMID: 37316837 DOI: 10.1186/s12909-023-04419-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND After a long phase without any propositions for real ambulatory training inside general practitioners' offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe. METHOD We carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses. RESULTS Representatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations. CONCLUSION This study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.
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Affiliation(s)
- Louise Devillers
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France.
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France.
| | - Sébastien Friesse
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
| | - Mette Caranta
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
| | - Vincent Tarazona
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Bastien Bourrion
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Olivier Saint-Lary
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
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Dixon J, Mendenhall E, Bosire EN, Limbani F, Ferrand RA, Chandler CIR. Making morbidity multiple: History, legacies, and possibilities for global health. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231164973. [PMID: 37008536 PMCID: PMC10052471 DOI: 10.1177/26335565231164973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/04/2023] [Indexed: 06/19/2023]
Abstract
Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing.
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Affiliation(s)
- Justin Dixon
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States
- Faculty of Health Sciences, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N Bosire
- Faculty of Health Sciences, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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García-Hernández M, González de León B, Barreto-Cruz S, Vázquez-Díaz JR. Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program. Front Med (Lausanne) 2022; 9:1033689. [PMID: 36507542 PMCID: PMC9729702 DOI: 10.3389/fmed.2022.1033689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.
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Affiliation(s)
- Miguel García-Hernández
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Silvia Barreto-Cruz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - José Ramón Vázquez-Díaz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain,*Correspondence: José Ramón Vázquez-Díaz
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