bridge this gap; formative education both in university and school is needed. Indeed, a culture is needed that changes the physicians' focus on patients as individual person within the population that focuses on his holistic care. The future of chronic and frailty care follow-up systems depends on: (1) human factors, (2) economics and (3) technology. The real ''technology'' is the human resource available in hospitals, homes and health and social care organizations. New care models need to respond to criteria of equity, simplicity, efficiency, efficacy, safety and patient-centeredness.
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