The General Directorate of the Patient and Chronicity of the Canary Islands Health Service (SCS) of the Government of the Canary Islands has reported that the AP-Cuida2 program, implemented in a standardized and automated manner in all Primary Care centers in the archipelago, has shown a clearly positive impact on the patient experience after hospital discharge.
Thus, since the pilot of this initiative was launched in January 2024, the SCS has registered 135,565 patients discharged administratively with a Nursing Care Report (ICE), of whom 134,394 have been scheduled with their primary care nurse or midwife at their health center, representing 99% of the total.By Health Areas, these patients with administrative discharge and ICE scheduled with their reference nurse or midwife are distributed as follows: 53,647 in Gran Canaria, 47,429 in Tenerife, 13,374 in Lanzarote, 8,931 in Fuerteventura, 8,376 in La Palma, 1,693 in La Gomera, and 944 in El Hierro
AP-Cuida2 continues its process of consolidation, improvement, and adaptation to different casuistries, both in the adult and pediatric population. Looking ahead to 2026, one of the main challenges is the progressive incorporation of other facilities in the Canary Islands' healthcare network, including contracted centers, especially in the follow-up of chronic patients after discharge following hospital admissions.
Very positive assessment from patients
According to a recently conducted survey, 95% of the people participating in the project found the contact made at the time of registration to be very useful
Specifically, this follow-up allowed 40% of patients to clarify doubts related to post-discharge care or prescribed medication, while 28% reported feeling accompanied during the transition process to homeFurthermore, this follow-up allowed 12% of patients to resolve administrative procedures, temporary disability processes, home care, or appointment requests remotely, thus avoiding trips to the health center
This high-level contact has also facilitated the identification of the caregiver in 54% of cases, a key element for ensuring the continuity and safety of patient care.
In relation to the needs identified after discharge, 57% of individuals required follow-up in continuity of care, primarily for wound care and advice, care related to ostomies, catheterization, or medication administrationLikewise, the program has made it possible to coordinate care by other professionals, such as Family and Community Medicine, midwives, or Social Work, in a scheduled manner, as well as to organize home care when necessary
Improved patient monitoring
For their part, the professionals participating in the pilot phase of AP_Cuida2 have evaluated this intervention very positively, highlighting that it has allowed them to connect with patients at a particularly critical moment such as hospital discharge, prevent complications associated with care, and proactively plan subsequent follow-upIn the same way, the program contributes to reinforcing the role of healthcare professionals and, in particular, Nursing, improving coordination between different care settings and avoiding fragmented care in a situation of greater vulnerability
Program AP_Cuida2
The AP_Cuida2 program is a pioneering project that seeks to facilitate care continuity for patients discharged after a hospitalization process, as a key element to optimize care, manage post-discharge processes, avoid hospital readmissions and unwanted emergency visits, as well as medication-related problems, being especially useful for chronic and elderly patients, fostering the relationship and trust between nursing staff and patients
Among the primary objectives of the General Directorate of Patients and Chronicity is to address care continuity between different levels, in such a way that the patient's relevant clinical information and the care they require are accessible from both Primary Care and Hospital Care, especially for patients requiring hospitalization due to acute or chronic pathologies.
AP_Cuida2 aims to guarantee patient safety and quality of care, while reducing travel, improving access to healthcare services and facilitating the monitoring of their progress after discharge, which in turn enables the implementation of mechanisms to cover their health problems
