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In the context of the VIGOUR project, the pilot region Valencia aims to increase its capacity for scaling up integrated care good practices related to healthy ageing. This shall be achieved by aligning resources and initiatives and by encouraging the use of ICT.
We in Valencia are living a status in which there is a list of initiatives in favour of healthy ageing. Most of them have been integrated under the umbrella of our reference site, which has received the top qualification (4 star) in the last assessment, in 2019 (https://ec.europa.eu/eip/ageing/library/2019-call-reference-sites-results_en). There is however, a certain disconnection between the main actors. The own reference site tried to limit so, and the formation of the ECHAlliance Ecosystem, VLCHealth (https://echalliance.com/ecosystem/valencia-health-ecosystem/), was also conceived as an effort to align resources and initiatives.
The case of VIGOUR responds in Valencia to that urgent need.
The very beginning was one good practice, CARMEN (Chronic Ailment Reduction after MENopause), registered in the commitment tracker of EIPonAHA (https://ec.europa.eu/eip/ageing/commitments-tracker/a3/lifestyle-improve-frailty-mood-cognitive-decline-and-quality-life-women_en). This is an example of vertical integration in which midlife, and also older post-menopausal, women have been joining an initiative of promotion of healthy lifestyle, mainly centred on the practice of sessions of physical activity in the facilities of the primary care centres. The sessions, 2 h per week, are first supervised and led by the primary care midwife but, to assure scalability, after a cycle of 3 months the own group of women organise themselves to continue without a limitation. For that, they use the centre facilities at hours different to those used by the midwife, who at that stage, is working with a new group.
The programme has been regularly run in two primary care centres of the metropolitan area in Valencia, (Foios and Massamagrell) and is being maintained with the participation of around 200 women. This number is being growing slowly, because of the expected losses in this sort of programmes due to insufficient adherence, something that is balanced, and positively growing, by the regular enrolment of new participants. To maintain adherence, the use of ICT technology was encouraged, and women were instructed on the networking opportunities provided by smart telephones. For that, a module of several sessions to educate in the use of internet was freely offered in the informatic rooms of the University (school of medicine and the faculty of psychology), and also directly face-to-face sessions given by one NGO, Cybervoluntarios (https://www.cibervoluntarios.org/es/blog/ver/mujeres-SalusVitae-Valencia). Another NGO, Asociación Salus Vitae (http://salusvitae.es/), which was supported by funds from a previous European project, provided support. Although not recently updated, the pictures in the website come from women and sessions in the CARMEN programme.
In this way, we warrant scalability, empowerment of the end-users, cost-effectiveness, and gender, because this is something addressed to cover the specific needs of women at that life period (menopause, susceptibility to disease like osteoporosis, metabolic derangements, anxiety and other psychological problems, etc).
Finally, this programme is connected with the Clínico-Malvarrosa University Hospital, who takes care of the regular health controls of those women in the Department of Obstetrics and Gynecology.
The programme has been also recognised by our regional health authorities, which have distinguished the initiative as a regional good practice.
The CARMEN programme has planned the extension to vulnerable groups, like for example that of cancer survivors (https://ec.europa.eu/eip/ageing/commitments-tracker/a3/lifestyle-improve-frailty-mood-cognitive-decline-and-quality-life-women_en). This has been initiated already a few years ago, but has suffered a slow progression since its presentation in the commitment tracker of EIPAHA.
Among the initiatives integrated in the Valencia reference site, a primary care centre in town has been promoting a programme not too different to CARMEN. This time both men and women were offered the practice of different options of physical activity, which this time was complemented with leisure activities, including “cultural walks”, etc. The primary care centre, named República Argentina, has included i) the own core of the programme, represented by the integration of care between nurses and family doctors, within the health profile, ii) the end users, through the development of the figure of the “expert patient”, who helps by taking charge of other users, and iii) the participation of the Red Cross, as a NGO, which received funding from the municipality for their programme of fight against the unwanted loneliness in the elderly people.
Another programme under development is ACTIVA, progressing through the enrolment in integrated care by family doctors, nurses, physiotherapists, and also expert patients. The prescription of physical activity for regular users of the primary care has been introduced in the electronic chart as an option similar to drugs. ACTIVA has been developed in the particular health department of the University General Hospital, distinct to the two previous initiatives, CARMEN and República Argentina, which are integrated in the health Department of the Clínico-Malvarrosa University Hospital.
VIGOUR has provided the opportunity to materialise a scaling up plan, which should be accomplished by the permeation between those 3 live programmes. A strategy has been prepared in which the key point, following the experience of the ACTIVA programme, has been the extension of the figure of the “expert patient”.
There is the explicit purpose of sharing, and extending, that figure in order to scale up in a cost-effective way the benefits of healthy lifestyle through integrated care.
There is awareness in that some more stakeholders need to be incorporated. The ACTIVA programme has approved the link with some private fitness centres, but given the public nature of the health centres, this is only as an information to the users.
Despite the existence of the ECHAlliance VLCHealth ecosystem and the reference site, the profile of the companies, still too few, does not fit with the features of the programmes.
There is more success in terms of NGOs, which have shown receptivity and commitment, as described above.
Social services still have an insufficient, if any, representation. This is most possible linked with the traditional disconnection between the health and the social services worlds in our country. We are aware of that, and possibly this is why the profile of end-users in or programmes is not that in need of their support, with the only exception of the Red Cross programme that, it should be said, is slightly separated from the core of the lifestyle promotion main objective.
Finally, the health authorities, represented by the public health service of our regional government, have been contacted and the purpose of their growing involvement has been declared. Much needs to be done, anyway, in that regard, because they themselves have designed own programmes that consume all their resources. The initial contacts have been reassuring, but the current status of the covid pandemia has interrupted any further progression.