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Coasts are complex natural and human systems subject to change via natural processes and human activity. Assimilation of this diverse set of drivers and responses and the relationships between them is a challenge in coastal management. We investigate the utility of the DAPSI(W)R(M) framework to identify indicators of environmental issues and the relations between human activities and the environment through a practical application on a coast with high levels of tourism-related activities. Components and indicators were assessed by a review of literature and existing data in the Málaga Province of southern Spain, focusing on coastal erosion and its relationship to the natural environment and social systems. The results indicate the utility of the DAPSI(W)R(M) framework to characterize key environmental issues that affect coastal areas, and provide an holistic vision of human activities and environmental processes. The application of this approach can improve coastal management through the development of a simple model that characterizes environmental issues from the causes to the consequences by means of indicators and the relationships between them. The cyclic form of the model permits an easy identification of where problems occur and who is involved with their resolution, helping with stakeholder mapping and decision-making regarding appropriate responses that can be taken to other administrative levels or other heavily developed tourist coastal areas. • The analysis of the utility of the DAPSI(W)R(M) to identify coastal environmental issues. • Environmental coastal proxies identifications and analysis of their relationship. • A practical management application on a southern Spain coast with high levels of tourism. • Notwithstanding some limitations, the DAPSI(W)R(M) approach offers a useful integrative tool for strategic management. [ABSTRACT FROM AUTHOR]

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention ( p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.