Fundació Puigvert↗︎
It is a collaborative initiative between the Nephrology Service of Fundació Puigvert and the Primary Care teams in the territory of the Integral Health Area (AIS) Barcelona Dreta.
It was established in 1998, when nephrologists José Ballarín and Francesca Calero visited primary care centers to present the Nephrology Service and work together on aspects related to chronic kidney disease (CKD) and hypertension.
Over time, new care, training, and coordination actions have been incorporated, consolidating a stable structure for joint work. The objective is to improve the detection, prevention, monitoring, and treatment of people with CKD, while promoting coordination between levels and efficient, patient-centered care.
What do we do?
The program facilitates joint work between Nephrology and Primary Care to improve care for people with CKD in the territory:
- Offer interconsultation without the patient as a support tool for case assessment.
- Assess and prioritize requests for first visits, adapting the response, care circuit, and attention time to the needs of each patient.
- Periodically update the CKD Care Pathway: patient care circuits between primary care and hospital care.
- Monitor quality indicators.
- Develop educational materials and support documents.
- Organize sessions in Primary Care teams, training courses, and annual joint conferences.
- Organize health education activities aimed at patients and their support network.
Who are we?
More than 25 professionals from Fundació Puigvert and the Primary Care teams in the territory AIS Barcelona Dreta constitute a stable multidisciplinary working group. Depending on the needs, the program also coordinates with professionals from the Hospital de Sant Pau and other services of Fundació Puigvert.
Integrated care, shared work, and territorial coordination are our three fundamental pillars. Some of the areas we work from are:
- Nephrology
- Family and Community Medicine
- Nursing
- Laboratory
- Clinical documentation and information systems
- Health management
Coordination: Patricia Fernández-Llama and Mª Antonia Llauger.
Information and resources for professionals
Diagnosis of CKD
The expected prevalence of CKD is 10-15%. Diagnostic criteria, screening, staging, indications, and key messages.
We care for renal health
Understanding risk factors and taking preventive measures can make a difference: primary, secondary, and tertiary prevention.
Renal deterioration
Clinical history, examination, confirmation tests, identification of the cause, and initial treatment. Urgent referrals.
Albuminuria and proteinuria
How and when to measure, confirm, and communicate. Initial assessment and treatment. Monitoring.
Anemia due to CKD
Anemia is a common complication in advanced CKD; it is important to diagnose and treat it correctly.
Recognitions received
Award for the Integrated Care Project (2020)
Catalonia Health Plan 2021-2025: Selected as a successful project (2021)
2nd Recognition Program: 25 years of integrated care for CKD (2025)
Publications
- Chapter: “Integrated Nephrological Care,” included for the first time in the reference book of the specialty. Francesca Calero and Patricia Fernández-Llama. Clinical Nephrology, 2022 (5th edition), Editorial Médica Panamericana. ISBN: 9788491106821.
- Published article: “25 Years of Integrated Chronic Kidney Disease Care: A Sustainable Collaboration Model Between Nephrology and Primary Care in Barcelona” Patricia Fernandez-Llama et al. Nephrology, 2026.
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