出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : There is wide-reaching agreement on the challenges arising from population ageing and, particularly, in regard to sustainability of the social and healthcare systems. A new model of care must place greater emphasis on prevention and proactive care. The Basque Country is one of regions in Europe with the most elderly population, which is why the Public Administrations, and particularly the Basque Government, work intensely to transform its services. The Basque Telecare Service BTS is a reference in this transformation, through 3 areas: socialcare-healthcare coordination, person-focused care and the intensive use of ICTs. Practice change : Telecare is a social service tied to primary care, strongly consolidated in Spain and highly appreciated. It is a service traditionally intended for emergency situations and is therefore based on a reactive model. However, in the present decade, and with clear-cut leadership of the Basque Country, Telecare is being adapted to the new needs, reinforcing the preventive and proactive focus. Targeted population : BTS is intended for different target populations: the elderly, people with disabilities, and people with mental illness. Particularly, in situations of risk because of loneliness, due to the effect this has on people’s health. Timeline : In 2011, the telecare service became a competence of the Basque Government it was formerly allocated in the local councils, and it is now a single service for all of the population. It is an instrument of mediation between social services and home care, and with health services. In 2016 a new stage was launched towards Personalised Telecare. Highlights : After the involvement of the Basque Government, the population using the Telecare has doubled, now encompassing more than 47,000 people 44% of women in Basque Country over the age of 85. 59% of the users live alone. The integrated social-health focus has become a catalyst for innovation, and specifically includes additional services: advice on health matters, help with making physician appointments, collaboration in the flu vaccination campaign, carers support and detection of physical and economic abuse. Sustainability and transferability : The BTS costs €193.29/person/year, and the user population pays their share of €39.38/person/year. These figures clearly demonstrate its sustainable nature, backed by the high quality perceived by the population. Many regions of Spain and, in general, of Europe, have shown interest in the BTS. Conclusions and lessons learnt : For decades, societies have equipped themselves with a strong healthcare system capable of dealing with acute diseases. The social services, however, have not required the existence of a powerful network given that care was provided by the family environment, and especially by the women. When the prevalence of disease shifts from acute to chronic, and when the care required must also be addressed from a more professional and institutional environment, increasing dysfunctions appear. The Basque Country’s commitment to a social service such as Telecare confirms that, over and above the enormous importance of having a quality public healthcare system, it is essential to act on social factors in order to maintain and improve health.
