Multidisciplinary primary care teams in Spain provide person-centred care

31 October 2018

Spain has prioritized the creation of multidisciplinary care since the adoption of the Primary Health Care Reform Act in 1985, inspired by the Alma-Ata Declaration.

Today, primary health care services are provided by community-based, multiprofile teams, each serving about 20 000 people.

Multidisciplinary care is a game-changing approach, considered an alternative to traditional institutionalized care. It makes the best use of the skills mix of the health workforce: multiprofile teams include family doctors, paediatricians, dentists, primary care nurses, nurse aides, social workers and health administrative staff. Health workers interact closely with patients and families, draw up patient-specific treatment plans and share responsibility for decisions on the patient’s health.

Since introducing these multiprofessional teams, Spain has seen a continuous improvement in the management of noncommunicable diseases, particularly diabetes mellitus and chronic obstructive pulmonary disease. The country now plans to link these multidisciplinary care teams with social services and emergencies, further improving the delivery of person-centred care.

Spain’s multiprofile care teams are among the many examples of good practice which will be shared to inspire policy-makers attending the high-level regional meeting, Health Systems Respond to NCDs, taking place on 16–18 April in Sitges, Spain.

Antoni Peris i Grao

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This multiprofile primary care team in Catalonia includes 14 family doctors, 3 paediatricians, 1 dentist, 21 primary care nurses, 3 nurse aids, 1 social worker and 12 health administrative staff.

Antoni Peris i Grao

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Teamwork is fostered by keeping aside an hour a day for team activities such as clinical training or coordination sessions.

Antoni Peris i Grao

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As in other multiprofile primary care teams in Spain, nurses play a key role in prevention, promotion and health education. They are the first point of care for emergencies and help resolve over 70% of acute cases.

Antoni Peris i Grao

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The continuous development and uptake of information systems for clinical practice and health services management has helped multidisciplinary care. Electronic health records allow health workers to keep and share a single database, prescribe diagnostic tests and medicines, and coordinate patients’ treatment in a holistic way.

Antoni Peris i Grao

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Electronic records also provide information on patients’ likelihood of developing chronic diseases, and help get patients’ health priorities right.

Antoni Peris i Grao

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Multiprofessional care teams in Catalonia have helped bring down by 37% the rate of chronic pulmonary disease – an under-diagnosed, life-threatening lung ailment.

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