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Scores obtained in global dimensión.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Jesús Prunera-Pardell, Susana Padín-López, Adolfo Domenech-del Rio, Ana Godoy-Ramírez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Prunera-Pardell" ] 1 => array:2 [ "nombre" => "Susana" "apellidos" => "Padín-López" ] 2 => array:2 [ "nombre" => "Adolfo" "apellidos" => "Domenech-del Rio" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Godoy-Ramírez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130862117301894" "doi" => "10.1016/j.enfcli.2017.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862117301894?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147918300158?idApp=UINPBA00004N" "url" => "/24451479/0000002800000001/v1_201802071807/S2445147918300158/v1_201802071807/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Integrated care and the challenge of chronic illness" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "4" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Joan Carles Contel" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Joan Carles" "apellidos" => "Contel" "email" => array:1 [ 0 => "jccontel@gencat.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Programa Prevenció i Atenció a la Cronicitat, Departament de Salut, Plan de Atención Integrada Sanitario y Social (PIAISS), Universidad de Barcelona, Sitges, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La atención integrada y el reto de la cronicidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The ageing of the population is one of the most important social and sociological phenomena if this century. The concept denominated “demographic transition” is affecting our country with unprecedented intensity, given that by mid-century approximately 35% of the Spanish population will be over the age of 65 years old, and 15% will be over the age of 80. The corresponding figures now stand at 17% and 5%, respectively.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> The direct relationship between ageing, chronic diseases and multiple morbidities is clear, and 64%–82% of those over the age of 65 years old are currently estimated to be affected by multimorbidity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Moreover, multimorbidity usually leads to situations that are hard to manage and require an increase in healthcare and social resources.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a> Many social factors determine and worsen this complex situation, and they should be identified and managed using healthcare and social policies as far as possible, ensuring equal treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Together with this clinically complex situation, another factor is the increasingly diversified and fragmented nature of our healthcare and social care systems. There tends to be little coordination between services, and financing and contracting systems function more as barriers than they do as facilitators, while information systems are not sufficiently interconnected.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Chronic conditions and complex chronic conditions in particular, are a challenge that obliges governments, organisations, teams and individual professionals to offer new services and act in new ways. The Pan American Health Organisation (PAHO)/World Health Organisation (WHO),<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> in the document <span class="elsevierStyleItalic">Innovative Care for Chronic Conditions</span>, define the attributes of effective care for chronic conditions: <span class="elsevierStyleItalic">planned proactive care</span> that centres on the individual and the needs of the population, with a clear focus on prevention based on primary health care.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This editorial proposes a form of comprehensive care that is based on the strengths and resources of our healthcare system. It suggests the changes that are necessary to provide an efficient, high quality, safe and cost-effective response to individuals with chronic diseases, especially those with more complicated conditions and those who are at more advanced stages of chronic disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Person-centred care</span><p id="par0030" class="elsevierStylePara elsevierViewall">An approach that is centred on the individual as a whole involves attending to all of the possible health risks that affect them when they consult health services. Visits to primary care (PC) may and should be the opportunity to detect and care for chronic diseases. Any event or acute disease must be seen within the context of conditions or broader risks that a person may be exposed to. If we want a chronic illness-oriented care model that ensures safe high-quality care and which really responds to individual problems and those of the population, we have to allow them to “speak out” to give the model content and a narrative: a structured methodology is indispensable for this.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Evidence-based practice must be combined with person-centred care to ensure that professionals and patients/individuals participate in a shared process and dialogue. They will reach shared decisions in a relationship based on equality, responsibility and trust, while also guaranteeing that clinical practice will be based on the best available evidence.</p><p id="par0040" class="elsevierStylePara elsevierViewall">People and citizens increasingly demand information and knowledge about their health or disease. The healthcare system must drive the definitive empowerment of citizens and patients in the field of health by developing their capacities and skills. This will have the aim of achieving the optimum self-management of their health processes, leading to a higher quality of life.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Primary care as the foundation of the model</span><p id="par0045" class="elsevierStylePara elsevierViewall">The literature is conclusive and convincing in that it is impossible to construct a good model for chronic patient care without a good PC system.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Our PC model must therefore be protected and consolidated to ensure good care for chronic patients, so that it clearly plays a planned and leading role in the management of individuals with complex conditions of multiple morbidity.</p><p id="par0050" class="elsevierStylePara elsevierViewall">PC in Spain is one of the main strengths of our healthcare system. Its model of community nursing sees this challenge as a major opportunity for professional definition and leadership, such as it has never faced in the past. This is in spite of the necessary reforms which PC has to undergo in our country.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The nurses who specialise in family and community medicine possess the skills and training to provide effective and cost-effective care for individuals with chronic conditions in the community. The cases in which nurses have developed advanced techniques to respond effectively in a coordinated and cost-effective way to individuals with multiple morbidities or highly complex conditions deserve special mention. There is already proven evidence in this field of the quality, safety and effectiveness of their response. The nurses who manage such cases have a high level of skills and training that lead them to apply evidence-based practice, while also supporting, advising and training the teams they belong to.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Person-centred care requires PC that is able to innovative in its structure, its vision and its organisation so that it is able to respond to individuals in their homes. The main aim of all care programmes for complex and advanced chronic patients has to centre on offering safe and high quality care to allow them to stay at home with the highest possible degree of independence. The only way to achieve this is to implement proactive and planned home care programmes which focus on comprehensive care and the prevention of complication in patients and their carers. Another key factor in offering high quality and safe home care is the implementation of an organisational structure which guarantees that it functions 24/7; for this it is indispensable that key data be visible for all of the professionals who may take part in caring for the individuals in question at times of crisis. This is because it is vitally important to know patient priorities and preferences, together with the protocols they have agreed in shared decision-making with their own healthcare professionals in their care plan.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">A comprehensive care model to ensure that care centres on the needs of the population</span><p id="par0065" class="elsevierStylePara elsevierViewall">Focussing on the population means that health systems are used to optimise the health of communities in general and over the long-term. Care has to be proactive, participative and preventive to achieve this aim.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As a result of this focus on the population, “local care systems” have to be constructed. In these hospitals and medium-stay or social-healthcare facilities must be properly coordinated with PC, with structured support to ensure that individuals are always seen in the appropriate area, preventing functional deterioration and guaranteeing the continuity of care.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The proposed population-based model of care for chronic patients involves adapting and even transforming classical care resources. The final aim is to strengthen patient community and home care as the core means of promoting alternatives to conventional hospitalisation. The PC system will play a very active role in this, fully coordinating its work with those of the social services.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Although in a first phase chronic patient care models contributed to the creation of coordinated and integrated environments within healthcare, the model must also include the social services.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Good practices for the segmentation and identification of populations at risk already exist outside the context of the healthcare sector. We have to learn from the world of organisations which are expert in identifying especially interesting sub-populations. Our systems include methods such as stratification. These make it possible to classify and identify population segments at different levels of risk and which require different approaches. This is especially so for patients in complex situations.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Key factors for progressing towards change</span><p id="par0090" class="elsevierStylePara elsevierViewall">The literature contains highly interesting reviews, although they also contain many limitations. This is because they do not describe in sufficient detail the different interventions that may have the greatest impact and efficacy in care models.</p><p id="par0095" class="elsevierStylePara elsevierViewall">To progress from patient-centred care to care that focuses on the needs of the population it is necessary:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To have brave and innovative social and health policies that are able to drive disruptive changes in organisations through suitable financing and decided macro</span>, meso and micro leadership in the health and social services. This favours a new evaluative, contracting and financing framework which promotes “functional integration” at a territorial level. Evaluation in sealed compartments by different parts of the system has to be surpassed by including indicators that are common and shared by PC, hospital and social services. The literature contains an increasing amount of evidence regarding financing models that favour integration.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The technological development of platforms that make it possible for professionals to work together and communicate while ensuring confidentiality, as well as allowing individuals access to their clinical histories.</span> Technologies that are now habitual in everyday life <span class="elsevierStyleItalic">(WhatsApp)</span> have yet to reach our sector, and there can be no doubt they will add a lot of value to this collaboration.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A population-centred multifactorial strategy</span> which proactively seeks the synergic combination of different interventions in the same population to achieve a person-centred comprehensive model of care that has real “impact”. There are highly interesting reviews in the literature which contain many limitations, as they do not describe in sufficient detail the different interventions in care models that may have the greatest impact and efficacy.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The development of the family and community nursing speciality with all of its skills</span> is of key importance to achieve leading, strong and sustainable PC. The nurses who specialise in family and community nursing will be of key importance in ensuring the continuity of high quality home care for the most delicate and dependent individuals. They will undertake preventive interventions and methodologically and rigorously promote health, together with citizen and chronic patient participation in their health-disease process. Specialist family and community nurses add value that is indispensable for the successful implementation of a new model of care that centres on PC, to be accessible, equitable, high quality and sustainable.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical leadership:</span> the organisation must ensure clinical leadership in the construction of the model. Managers and professionals must work together in the development of the “systemic leadership” skills that will help to construct comprehensive care models.</p></li></ul></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">No single area or professional is able to respond effectively to the complex needs of individuals with multiple morbidities and complications. This is why it is indispensable to advance towards management of these patients in cooperation with the social services, ensuring that they are evaluated and that a shared care plan is prepared for them. This plan will identify their health and social problems and thereby will supply the most suitable resource in the best area of care for them.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Information systems are a fundamental tool in aiding change, sharing information with patients, helping to reach decisions, guaranteeing safety and continuously evaluating the model.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Individuals with complex and advanced chronic diseases require major social and healthcare resources. We are therefore ethically obliged to advance towards comprehensive care models that ensure effective coordination and collaborative management by the social and healthcare agencies, responding in a way that is both high quality and cost-effective.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The development of community nursing skills and the speciality of family and community nursing are of key importance to guarantee that care of the population is high quality, safe and sustainable.</p><p id="par0145" class="elsevierStylePara elsevierViewall">We therefore see that all of the above descriptions and proposals could not be more encouraging for the development of the nursing profession. We are able to put into practice strategies for change that respond to people's needs, ones that will definitively stimulate our profession for the good of the population.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Person-centred care" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Primary care as the foundation of the model" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "A comprehensive care model to ensure that care centres on the needs of the population" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Key factors for progressing towards change" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Contel JC. La atención integrada y el reto de la cronicidad. Enferm Clin. 2018;28:1–4.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0010" href="http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#.WjUXYFXhDZ4">http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#.WjUXYFXhDZ4</span> [accessed 02.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health at a glance 2017: OECD indicators" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Organisation for Economic Co-operation and Development" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "OCDE" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perfil y evolución de los pacientes crónicos complejos en una unidad de subagudos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Gual" 1 => "A. Yuste-Font" 2 => "B. Enfedaque Montes" 3 => "C. Blay Pueyo" 4 => "R. Martín Álvarez" 5 => "M. Inzitari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aprim.2016.11.010" "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "2017" "volumen" => "49" "paginaInicial" => "510" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28292582" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0015" href="http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/aug/1764_hong_caring_for_high_need_high_cost_patients_ccm_ib.pdf">http://www.commonwealthfund.org/∼/media/files/publications/issue-brief/2014/aug/1764_hong_caring_for_high_need_high_cost_patients_ccm_ib.pdf</span> [accessed 21.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caring for high-need, high-cost patients: what makes for a successful care management program?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Hong" 1 => "A. Siegel" 2 => "T. Ferris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2014" "editorial" => "The Commonwealth Fnd" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0020" href="http://www.commonwealthfund.org/~/media/files/publications/fund-report/2017/aug/roland_10_recommendations_for_complex_patients_revisedexpanded.pdf">http://www.commonwealthfund.org/∼/media/files/publications/fund-report/2017/aug/roland_10_recommendations_for_complex_patients_revisedexpanded.pdf</span> [accessed 02.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Designing a high-performing health care system for patients with complex needs ten recommendations for policymakers" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The Commonwealth Fund International Experts Working Group on Patients with Complex Needs" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "The Commonwealth Fund" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0025" href="http://www.nejm.org/doi/full/10.1056/NEJMp1608511#t=article">http://www.nejm.org/doi/full/10.1056/NEJMp1608511#t=article</span> [accessed 12.11.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caring for high-need, high-cost patients — an urgent priority" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Blumenthal" 1 => "B. Chernof" 2 => "T. Fulmer" 3 => "J. Lumpkin" 4 => "J. Selberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1608511" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "375" "paginaInicial" => "909" "paginaFinal" => "911" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27602661" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0030" href="https://www.nice.org.uk/guidance/ng22">https://www.nice.org.uk/guidance/ng22</span> [accessed 02.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Older people with social care needs and multiple long-term conditions. NICE guideline [NG22]" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National Institute for Clinical Excellence" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2015" "editorial" => "NICE" "editorialLocalizacion" => "London" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organización y prestación de atención de alta calidad a las enfermedades crónicas no transmisibles en las Américas" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Organización Panamericana de la Salud/Organización Mundial de la Salud. Cuidados Innovadores para las condiciones crónicas" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "OPS/OMS" "editorialLocalizacion" => "Washington" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0035" href="http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0132340%26type=printable">http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0132340&type=printable</span> [accessed 09.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of case management for “at risk” patients in primary care: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Stokes" 1 => "M. Panagioti" 2 => "R. Alam" 3 => "K. Checkland" 4 => "S. Cheraghi-Sohi" 5 => "P. Bower" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0132340" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "e0132340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26186598" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0040" href="http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7902#fullreport">http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7902#fullreport</span> [accessed 02.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health and social care integration number 7902" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Houses of Parliament (UK)" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "Houses of Parliament" "editorialLocalizacion" => "London" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24451479/0000002800000001/v1_201802071807/S2445147918300183/v1_201802071807/en/main.assets" "Apartado" => array:4 [ "identificador" => "63166" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451479/0000002800000001/v1_201802071807/S2445147918300183/v1_201802071807/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147918300183?idApp=UINPBA00004N" ]
