In Spain, more than half of the population lives with at least one chronic disease, a reality that worsens with age and puts pressure on primary care (PC) teams on a daily basis. Diseases such as chronic obstructive pulmonary disease, asthma and heart failure … Heart disease (HF), chronic kidney disease (CKD), and diabetes mellitus (DM) represent a significant portion of the healthcare burden: COPD affects approximately 10% of those over 40 years of age; Asthma, 5% of adults and 10% of children3; HF is estimated at approximately one million people4; Chronic kidney disease affects 15% of the population; The incidence of diabetes is approximately 14%, with a higher prevalence after age 65 years. Given this panorama, computer strengthening and coordination of different levels of care is a priority to ensure system sustainability and improve health outcomes.
In this context, the CARABELA-AP7 project was born, an initiative promoted by SEMERGEN, SEMG and SECA in collaboration with AstraZeneca, designed to promote comprehensive, coordinated and measurable management of these five prevalent chronic diseases.
Dr. José Polo Garcia, President of the Spanish Society of Primary Care Physicians
Its ambition is clear: to strengthen the PC, the backbone of the national health system. Family medicine faces a great challenge: to be the basis for dealing with all diseases, to prevent the progression towards chronic diseases, and also to contribute to a more efficient management of health expenditure.
A project with national representation and a realistic outlook
CARABELA-AP is a collaborative and practical framework that places AP at the center of chronic disease management. To ensure that the model is workable and equitable, CARABELA-AP integrated 104 health centers into the design and validation phase of 17 health areas (one for each autonomous community), with 142 health professionals of different profiles. This design ensures organizational and regional diversity, and faithful analysis of the reality of Spanish PA, both in urban and rural settings.
“CARABELA-AP has given us a common map of the care process for patients with asthma, COPD, heart failure, chronic kidney disease and diabetes,” explains Dr. José Polo García, President of the Spanish Society of Primary Care Physicians (SEMERGEN). “With clear steps, common standards and specific coordination, we can reduce variability and achieve clinical safety for the patient and the teams.”
A measure of improvement: health care quality indicators
One of the project’s great contributions is the indicator framework that allows monitoring the real impact of solutions and fine-tuning implementation by centre, region and autonomous community. Additionally, it facilitates comparisons between teams to learn from best practices and scale what works. “The strength of CARABELA-AP is the consensus and data,” says Dr. Pilar Rodríguez Ledo, President of the Spanish Society of General Practitioners and Family Physicians (SEMG). “We validated what we were doing really well and discovered choke points: unequal access to testing, wait times, lack of referral protocols, staff turnover, or lack of interoperability.
The project does not stop at diagnosis: it proposes concrete and measurable solutions that we can begin to implement. In this sense, the application of the CARABELA-AP recommendations can contribute to strengthening multidisciplinary coordination, standardization of protocols, continuous training of health professionals and patients, and equitable access to diagnostic resources.
Dr. Immaculada Mediavilla, President of the Spanish Society for Quality in Healthcare
Technology and patient education: key pillars
Education targeting patients and their families is essential to enhance understanding of the disease and their active participation in the care process, as well as assist them with self-care and improve adherence to treatment. The adoption of digital tools is emerging as a major accelerator, whether in coordination between different levels of care or in communicating with and monitoring patients.
Its implementation would facilitate more efficient recording and analysis of data related to various diseases, contributing to early diagnosis and care according to the characteristics and needs of each patient. “Technology is the bridge between what we know works and our ability to do it at scale,” says Dr. Inmaculada Mediavilla, president of the Spanish Society for Healthcare Quality (SECA). “If the team can see its indicators and performance, the whole department improves. The ultimate goal is a more proactive and predictive computer, which identifies early who will benefit most from intervention.
Towards implementation: evidence as a tool for change
The following efforts focus on implementing solutions based on the roadmap obtained in CARABELA-AP and monitoring their impact through quality indicators. The goal is not only to improve the management of these five priority diseases, but to create a replicable framework for other chronic diseases. In short, moving towards a more proactive, coordinated and humane model of care, able to respond to the challenge of chronicity with efficiency, equity and health outcomes.
Dr. Pilar Rodríguez Ledo, President of the Spanish Association of General Practitioners and Family Physicians
Because when PCs have clear processes, training, useful technology and coordinated teams, everything changes: they are diagnosed earlier, treated better and live more quality lives. CARABELA-AP presents this roadmap, based on the reality of our centers and the commitment of those who support them every day. With a common goal: to put the chronic patient at the center and measure what matters to truly improve their lives.
“At AstraZeneca, we believe that public-private collaboration, based on science and measurement, is key to transforming chronic disease care,” says Ana Pérez, Director of Clinical and Regulatory Affairs at AstraZeneca in Spain. “CARABELA-AP is a joint effort with SEMERGEN, SEMG and SECA that puts primary care at the centre. Our commitment is to support the adoption of scalable solutions, accompany measurement tools, and contribute to achieving a more coordinated, equitable and sustainable PA system.”
To date, 260 workshops have been held involving more than 12,000 professionals from 1,035 health centres, with the potential to cover approximately 7.5 million people from the autonomous communities concerned.
References
1. Patient Care Observatory. Report 2021. Available at: report2021_oap_vf_2.pdf. Last access: October 2025
2. Boza E, et al. Chronic obstructive pulmonary disease (COPD) in Spain and different aspects of its social impact: a multidisciplinary opinion document. Rev. Esp Alchemist. 2020;33:49-67.
3. Blanco-Aparicio M, et al. Study of the prevalence of asthma among the general population in Spain. Open the Respera bow. 2023; 5:100245.
4. Sikras-Maynaar A, et al. Epidemiology and treatment of heart failure in Spain: the HF-PATHWAYS study. Rev. Esp Cardiol. 2022; 75: 31-8.
5. Gorostedi M, et al. Chronic kidney disease in Spain: prevalence and impact of accumulating cardiovascular risk factors (article in English and Spanish). Nephrology (English Edition). 2018; 38: 606-15.
6. Ciprian Cuenca AM, et al. Prevalence of obesity and diabetes in Spain. Development in the past ten years (article in Spanish). Aten Primary School. 2024; 57:102992.
7. Polo G, et al. Redefining primary care: CARABELA-AP recommendations for the management of prevalent chronic diseases. Simergen Family Medicine 2025; 51:102586