**3.2 Integrated care and model practices**

The National Health Plan [12] "seeks to strengthen primary care and provide greater access to comprehensive and quality treatment through better care integration and a more adequate professional skill-mix across care levels". The upgrading of family medicine practices in 2011 was an innovative government initiative to improve care coordination and the management of chronic diseases. Upgraded primary health care teams or 'model practices' include a designated nurse who has a part time responsibility to screen for chronic disease risk factors, preventive counseling and care coordination. Additional nurse received specific training including screening for chronic disease risk factors and preventive counseling for patients aged 30 and over, as well as the care coordination of all registered patients with a stable chronic disease. Following the asthma and chronic obstructive pulmonary disease (COPD) modules [13], training was expanded to include the arterial hypertension, coronary disease, diabetes [14], and osteoporosis and prevention modules [15]. The purpose of family medicine "Model practices" operation is to improve the quality of work with an active approach in the promotion of health, screening for the most current health problems of the adult population and systematic management and monitoring of patients with stable chronic diseases. The new way of increased the accessibility of the whole population to high-quality and safe healthcare.

By 2014, about half of all primary care provision was in such 'model practices' and by 2018 most practices included an additional nurse. Annual costs for model practices are estimated to 13 million EUR, the effects of their functioning have not been evaluated yet.
