Abstract
Background: The +AGIL Barcelona program is an evidence-based, real-world, multidomain, and multidisciplinary initiative aimed at promoting healthy aging by enhancing older adults’ intrinsic capacity through a coordinated approach involving primary care, geriatrics and community resources. It aligns with the WHO’s ICOPE guidelines, emphasizing functional independence and an active lifestyle. Co-designed with healthcare professionals and end-users, the program bridges the gap between research findings and real-world practice. Initially implemented at one Primary Care Center (PCC), it showed significant improvements in physical function at three months, sustained at 6 months - even among individuals with cognitive decline. Building on its success, +AGIL is scaled to three PCCs with varied socio-demographic profiles, optimizing local resources to create a sustainable, person-centered care model.
Approach: The implementation follows a stepped-wedge, cluster-randomized design, integrating a complex intervention into routine care. Each PCC begins with a baseline control period during which the +AGIL model is co-designed to fit local contexts. Participatory co-creation methodologies, including focus groups and technical sessions, are guided by Participatory Action Research (PAR) principles and actively engaged stakeholders – healthcare professionals, community agents and older adults.
To ensure governance and share learning, a motor group oversees the global coordination and strategic decisions, while local implementation groups adapt and manage the program's day-to-day operations. Continuous evaluation identifies barriers and tailors solutions to diverse socio-economic contexts, ensuring seamless integration into routine clinical practice.
Results: Preliminary findings indicate high acceptance of the +AGIL Barcelona across PCCs, with improved coordination between healthcare and community resources. The co-creation process yields practical tools, including a desk prism for healthcare professionals, a foldable physical activity guide, and informational brochures for participants and community agents. These tools have strengthened community engagement and empowered stakeholders to support program delivery actively.
Implications: The +AGIL Barcelona program exemplifies key pillars of integrated care: a) Person centered-care, co-design approach prioritizes individual autonomy, aligning interventions with participants’ needs and preferences; b) coordinated care, the program fosters collaboration between healthcare providers and community agents to deliver accessible, continuous care that supports aging in place; c) system-based approach, levering existing healthcare and community assets, the program demonstrates system integration and resources optimization.
The program’s sustainability and adaptability showcase a model of collaborative leadership and continuous improvement. Its flexible design translates scientific evidence into real-world clinical applications, bridging the gap between research and practice.
A unique strength of +AGIL Barcelona lies in its bottom-up development: healthcare teams at each PCC lead the design and solutions, ensuring contextual relevance and alignment with existing workflows. This approach enhances sustainability, supports integration into daily clinical operations, and fosters long-term engagement.
Through its replicable and scalable model, +AGIL Barcelona addresses the complex challenges of an aging society, paving the way for inclusive, person-centered, and sustainable healthcare solutions for older populations.