Kronik ON Programme - Multimorbid patients empowerment by online educational materials (Osakidetza - Basque Country)

Osakidetza, Basque Health Services, has developed a series of online resources to facilitate citizen access to health services and improve their capacity to make decisions and manage their illness by empowerment programmes and tools. KronikON programme is a structured and standard corporate, on and offline, programme for individual empowerment of the multimorbid patient and/or caregiver. It was developed in 2015 within the European project Carewell by a working group composed by nurses from both primary and hospitalized care.

The program, carried out by each chronic patient and/or caregiver professional of reference, is structured in four sessions, one session per week, and a reminder session 2 months later. The duration of each session is estimated 30 minutes long, and is developed at the Primary Health Center or at Patient´s home through digital tools. During the sessions different activitites are performed: an assessment of the empowerment degree is done, reinforcing self-managment, widering knowledge, etc. All the activities and educational materials provided by healthcare proffesional are registered in the Electronic Health Record, Osabide Global. In 2021, a fifth session target to patient's main caregiver has been included in the programme with the aim of empowering caregivers with skills and tools to provide quality care, detect any overload and acquire healthy self-care habits. 

The objectives defined and to be achieved in Kronik ON programme are:  

  • Assessment of the patient
  • Identification and explanation of the pathologies
  • Adherence to treatment
  • Valuing empowerment
  • Close purposes and objectives
  • Self-monitoring of symptoms and alarm signs
  • Assessment of the situation of the carer
  • Prevention and early detection of the carer's overload and needs. 

Once the educational programme has been completed, after two months, a follow-up session is scheduled to reinforce everything that has been learned and adquired previously.

All the materials developed  (videos, leaflets and presentations) are available online in the School of Health of Osakidetza ("Osasun Eskola") website. As a next step, Osakidetza is evaluating the possibility of offering the program through the Zoom online platform.

All education materials are available in Osakidetza

Clibeanna
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