• María Cecilia Arechabala-Mantuliz, Noelia Rojas-Silva, Marcela González-Madrid, Claudia Bustamante-Troncoso, Claudia Alcayaga-Rojas, and Gloria Rojas-Díaz.
• Departamento de Salud del Adulto y Senescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile.
• Rev Med Chil. 2022 May 1; 150 (5): 664671664-671.

AbstractPeople with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.

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