[Equity and patient autonomy in the care strategies for patients with chronic disease of health services in Spain]

Abstract

Objective: To examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components.

Method: Narrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments' web pages, using the terms "Programmes", "Strategies", "Chronic patients", and "Chronicity".

Results: 15 programmes were found. Most of them include all components of the chronic care model, "decision-making support" being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease.

Conclusions: Chronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease.

Keywords: Autonomía del paciente; Chronic disease; Enfermedad crónica; Equidad en salud; Health equity; Managed care programme; Personal autonomy; Programa de atención en salud.