Validity of Starfields model in the chronic care strategies of the Canary Islands (2015-2024)

Abstract

Objective: To analyse the alignment of the Plan 5 C (Plan for the care of people with highly complex chronic conditions, 2024) and the Canary Islands Strategy for Tackling Chronicity (2015) with the Primary Care (PC) model according to Starfields four core attributes (4Cs), assessing their correspondence with the evaluation framework of the Spanish National Health System (SNS) and with the domains and items of the PCAT-A10. Design: Descriptive, comparative documentary analysis. Setting: Canary Islands (Spain). Participants: Not applicable. Documentary analysis study with no human subjects. Methods: The READ method was applied to analyze both strategies and their correspondence with the 4Cs, PCAT-A10 domains, SNS indicators, and the interpretive criteria of the critical review by Minu & eacute;-Lorenzo and Fern & aacute;ndez-Aguilar(2018). Results: Both strategies show conceptual convergence with Starfields attributes, especially in comprehensiveness and coordination. The Plan 5 C strengthens coordination through econsultations, committees and specific devices. The Strategy 2015 incorporates accessibility, socio-sanitary integration and support for self-care. The selective focus on highly complex chronic patients may strain universal accessibility and continuity if the interventions are not articulated from PC. SNS indicators focus mainly on organizational processes, while the PCAT-A10 assesses PC performance from a population perspective. Conclusions: Starfields 4Cs remain a valid framework for analysing chronic care strategies in the Canary Islands. Although the reviewed documents partially incorporate these attributes, their application is partial and heterogeneous. Integrating institutional indicators with population-based tools such as PCAT-A10 provides complementary perspectives for evaluating PC performance. (c) 2026 The Authors. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).