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1.
Objectives
To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government.Material and methods
A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods.Results
The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high.Conclusions
There are several opportunities to improve the efficiency of the Spanish NHS beyond the “anticrisis” measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures. 相似文献2.
Justo García Sanz-Calcedo Francisco CuadrosFernando López Rodríguez 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(6):549
Objective
The aim of this study was to evaluate the viability of energy audit as a management tool in primary care to improve the energy efficiency and environmental performance of a health center by reducing its operating costs.Method
We conducted 55 energy audits in health centers from 2005-2010. The health centers were sized between 500 and 3,500 m2, were located in health areas with 3,500 to 25,000 users, and were built between 1985 and 2007.Results
With an average investment of 11,601€ per site, energy consumption can be reduced by 10,801 kWh per year, saving 2,961€ with a mean payback period of 3.92 years, and preventing emission of 7,010 kg of CO2.Conclusions
Energy auditing is a practical tool to reduce the operating and maintenance costs of health centers and of improving the comfort of the facilities. 相似文献3.
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5.
Objective
Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers’ contracts.Methods
We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations.Results
The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability.Conclusions
In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers’ contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 相似文献6.
Alfredo Borda Belén SanzLaura Otero Teresa BlascoFrancisco J. García-Gómez Fuencisla de Andrés 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(2):151
Objective
To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain).Methods
We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities’ demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level.Results
The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively.Conclusion
Travel time to the mammography unit may help to explain participation in breast cancer screening programs. 相似文献7.
Ana Belén García-Garrido José Andrés Vázquez-Rodríguez Elena Grande-González María Ángeles Ramos-Barrón 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To analyze cervical cancer screening performed in Cantabria by evaluating the coverage and costs of screening and by calculating the available direct costs of the disease and the indirect costs of cervical cancer mortality.Methods
Screening for cervical cancer is performed in women aged between 21 and 65. According to the census for 2011 in Cantabria, there were 189.111 women in this age group. We performed a cross sectional, quantitative and qualitative study of the Pap smears performed and analyzed the direct and indirect costs of cervical cancer.Results
Between 2006 and 2011, 51% of women studied had one Pap smear, and 26% had two. In 2011, 31.554 Pap smears were performed in opportunistic screening in Cantabria, and the direct cost was 2,904.760 €. The annual direct cost of cervical cancer (average 2008-2010) was 567.567 €. The annual indirect costs (average 2001-2008) of cervical cancer was 386.122.02 €, in the reference scenario considered.Conclusions
Only 26% of women in Cantabria attended screening within the intervals recommended in the current opportunistic protocol. The cost data provided in this study may be useful for future economic evaluations. 相似文献8.
Jorge Díaz-SáezDaniel Catalán-Matamoros M. Milagros Fernández-MartínezGenoveva Granados-Gámez 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(6):483
Objective
To analyze first-time mothers communication with health professionals, and to explore satisfaction, needs and expectation towards healthcare services.Method
Qualitative design using in-deep interviews and phenomenology was used. First-time mothers from Huercal-Overa (Almería) were intentionally selected in 2010 and were included in the study. A hermeneutic analysis was performed.Results
Six meta-categories were obtained. Saturation of information was found with nine interviews. The meta-categories were the following: 1) Health professionals; 2) Pregnancy, partum and postpartum; 3) Communication; 4) Child nutrition; 5) Feelings; 6) Others. The mothers perceived as exciting this new experience and expressed feelings of fear, anguish and high sensitiveness. These feelings are increased by the information received from the family circle and the professionals which is referred low and contradictory. All professionals were positively considered, specially the midwife. The following negative experiences were identified: contractions, dilation and delivery. The end of the stay at the hospital was considered early and the time for consultation was short for the mothers. There is a demand about more information on breast feeding. Mothers wish health professionals to respect their decisions.Conclusions
The study found some areas for improvement in the communication between firs-time mothers and health professionals which could be taken into account in satisfaction promotion plans in regards to healthcare services. 相似文献9.
Joan de Pedro-Gómez José Miguel Morales-AsencioAlbert Sesé Abad Miquel Bennasar VenyGuillem Artigues Vives Catalina Perelló Campaner 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(3):191
Objectives
To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings.Methods
We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.Results
A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience.Conclusions
This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level. 相似文献10.
Concepción Cruz-Rojo Luis María BejarDaniel Jesús López 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(5):403
Objectives
To describe hospital admissions data in the Bay of Algeciras from 2001 to 2005 compared with the rest of Andalusia and Spain and to analyze the relationship between these data and the most frequent diagnoses leading to excessive premature mortality in this area.Methods
We carried out a cross-sectional study. The study population consisted of the residents of the municipalities of the Bay of Algeciras, obtained from the Population and Household Census of 2001. Age-adjusted annual average hospital admission rates were compared between the Bay of Algeciras (2001-2005) and the rest of Andalusia and Spain using the relative and attributable risk. Hospital admissions and premature mortality rates were compared by means of the relative risk of the most important causes.Results
Hospital admissions in the Bay of Algeciras were significantly lower for most of the diagnoses studied. There was also excessive premature mortality, especially for circulatory diseases (RR for hospital admissions: 0.79 in men and 0.87 in women; RR for premature mortality: 1.39 in men and 1.70 in women). Notable specific diseases were diabetes in both genders and cerebrovascular disease and liver cirrhosis in men.Conclusions
This study found a lower use of healthcare services and a higher risk of premature mortality due to severe diseases in this region. Further studies analyzing the potential socioeconomic and environmental determinants of the area are required. 相似文献11.
Objective
To compare time spent on unpaid work as measured by the Time Use Survey (TUS) 2002-2003 and the National Health Survey (NHS) 2006.Methods
The time spent on childcare, care of dependent adults, and housework was studied. The proportion of caregivers and the average amount of time spent on each activity, as measured by both surveys, was compared by gender, age and household size.Results
The estimated time spent on adult and childcare is four to six times higher in the NHS, whereas the TUS shows higher percentages of people devoted to housework and childcare. The results of the NHS and the TUS tend to converge only when they measure the proportion of people caring for dependent adults and the average amount of time spent on housework. 相似文献12.
Díez-Domingo J Ridao-López M Gutiérrez-Gimeno MV Puig-Barberá J Lluch-Rodrigo JA Pastor-Villalba E 《Vaccine》2011,29(52):9640-9648
Background
Heptavalent pneumococcal conjugate vaccine (PCV-7) was licensed to provide immunity against pneumococcal disease caused by seven serotypes of S. pneumoniae. Thirteen-valent pneumococcal conjugate vaccine (PCV-13) includes 6 additional serotypes for preventing invasive pneumococcal disease.Objective
The objective of this study was to estimate the potential health benefits, costs, and cost-effectiveness of vaccination with PCV-13 in the Community of Valencia and to generate valuable information for policy makers at regional and country levels.Methods
A decision tree was designed to determine the health and economic outcomes in hypothetical cohorts of vaccinated and unvaccinated children followed over their lifetime. Information about disease incidence and serotype distribution were gathered from local databases and from published and unpublished local records. PCV-13 effectiveness was extrapolated from PCV-7 efficacy data. A 5% of herd effect and a serotype replacement of 25% were considered for the base case scenario. Only direct costs were taken into account and results were expressed in terms of life-years gained (LYG) and quality adjusted life years (QALY).Results
Implementing a universal PCV-13 vaccination program in the Community of Valencia would decrease the number of hospital admitted pneumonia to less than 4571 cases while avoiding 310 cases of IPD and 82,596 cases of AOM throughout the cohort lifetime. A total of 190 S. pneumoniae related deaths would be averted over the same period. Total medical costs of non-vaccinating the cohort of newborns would reach up to 403,850.859 € compared to 438,762.712 € that would represent vaccinating the cohort. The incremental cost of vaccinating the children was estimated in 12,794 €/LYG and 10,407 €/QALY, respectively.Conclusions
A universal PCV-13 vaccination program in the Community of Valencia would be a cost-effective intervention from the payer perspective after preventing for pneumococcal infections and for decreasing its associated mortality and morbidity. 相似文献13.
Pablo Moya Martínez Mairena Sánchez López Julio López Bastida Francisco Escribano Sotos Blanca Notario PachecoFernando Salcedo Aguilar Vicente Martínez Vizcaíno 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(3):198
Objective
To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children.Methods
Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group.Results
The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (−1.25 mm, 95% CI: −1.82 to −0.67; P < .001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (−0.59%; 95% CI: −1.03 to −0.67; P < .001), and those with a BMI > P75 showed a decrease in triceps skinfold thickness (−1.87 mm; 95%CI: −3.43 to −0.32; P < .001), and percentage of body fat (−0.67%; 95%CI: −1.32 to −0.01; P < .05).Conclusions
This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners. 相似文献14.
Aim
To assess the cost-effectiveness of vaccinating all or subgroups of adults aged 60 to 85 years against herpes zoster.Methods
A deterministic compartmental static model was developed (in freeware R), in which cohorts can acquire herpes zoster according to their age in years. Surveys and database analyses were conducted to obtain as much as possible Belgian age-specific estimates for input parameters. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. as a function of the duration and severity of herpes zoster disease).Results
Uncertainty about the average SOI score for a person with herpes zoster, the duration of protection from the vaccine, and the population that can benefit from the vaccine, exerts a major impact on the results: under assumptions least in favour of vaccination, vaccination is not cost-effective (i.e. incremental cost per QALY gained >€48,000 for all ages considered) at the expected vaccine price of €90 per dose. At the same price, but under assumptions most in favour of vaccination, vaccination is found to be cost-effective (i.e. incremental cost per QALY gained <€5500 for all ages considered). Vaccination of age cohort 60 seems more cost-effective than vaccination of any older age cohort in Belgium.Discussion
If the vaccine price per dose drops to €45, HZ vaccination of adults aged 60-64 years is likely to be cost-effective in Belgium, even under assumptions least in favour of vaccination. Unlike previous studies, our analysis acknowledged major methodological and model uncertainties simultaneously and presented outcomes for 26 different target ages at which vaccination can be considered (ages 60-85). 相似文献15.
Manel Nebot Sandra ManzanaresMaría José López Carles Ariza Iñaki GalánAlbert Moncada Agustín Montes Mónica Pérez-RíosAnna Schiaffino Esteve Fernández 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(4):322
Introduction
In the last few years, health surveys and epidemiological studies on smoking have introduced questions on environmental tobacco smoke (ETS) exposure. However, a standardized questionnaire is lacking.Methods
Between January and May 2008, we reviewed surveys containing items on ETS exposure carried out in Spain by public administrations, scientific societies and research institutes. The wording of the questions was reviewed and classified according to the study type, target population, geographical setting and place of exposure.Results
We identified 27 surveys that included questions on passive smoking. Most were health surveys (81.5%) and were aimed at the general population (70.4%). The most frequent geographical setting consisted of autonomous regions (48.1%) and the most common place of exposure was the home (88.9%)Discussion
The results show wide variability in the questions used. Questionnaire items on ETS exposure should be homogenized to allow comparison of the results of surveys. 相似文献16.
Objective
To describe patients’ degree of knowledge about their diseases and advance directives, as well as their willingness to write these documents, among patients with chronic diseases seen in the emergency department.Methods
We performed a prospective, comparative, cross-sectional study, without intervention and with consecutive patient inclusion in two periods (2003 and 2008). Demographic and clinical data were recorded. An anonymous interview about patients’ knowledge and opinions about their illness and their awareness of advance directives was performed. Previous awareness of advance directives and the predisposition to write these documents were taken as dependent variables, and factors associated with these variables were analyzed.Results
In both periods, 381 patients with similar characteristics were included (191 in 2003 and 190 in 2008). Patients showed greater knowledge of their disease (74% vs 55%, p < 0,001), a greater predisposition to take part in medical decisions (62% vs 42%, p < 0,001), and higher participation in such decisions (48% vs 35%, p = 0.01) in 2008 than in 2003. However, awareness of advance directives was slightly lower (18% vs 23%, p = NS), and willingness to write these documents was unchanged (50% vs 50%, p = NS). Awareness of advance directives was associated with age less than 75 years and having completed secondary school. The predisposition to write advance directives was associated with previous awareness of these documents, considering oneself to be well informed, and wanting greater participation in medical decisions.Conclusions
Patients with chronic diseases showed greater understanding of their disease in the second period but awareness of advance directives and willingness to write these documents remained low. Information on these issues should be improved as an essential part of the physician-patient relationship. 相似文献17.
18.
María Gil Rosario MorenoMargarita Marín Ma Ángeles RomeuBárbara Gomila Francisco González 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(2):122
Background
This study aimed to identify tuberculosis transmission patterns in Castellón in a period of major demographic changes.Methods
A prospective study of patients with positive culture in the province of Castellon over a 4-year period (2004-2007) was carried out. Cases were described by year and nationality and were compared with those reported to the Department of Public Health. We studied the population with available molecular patterns, identified through restriction fragment length polymorphism (RFLP) and analyzed the variables from patient clusters, based on data collected in surveys of the Department of Health and the Laboratory Management Program.Results
According to data from the Department of Public Health, the overall rate of tuberculosis per 100,000 inhabitants in the province of Castellón was 15.7 in 2004, 19.9 in 2005, 18.2 in 2006 and 17.5 in 2007. In our laboratory, strains were identified from 301 patients, representing 77% (301/390) of reported cases and 94% (301/321) of reported cases with a positive culture. The percentage of tuberculosis among foreigners increased with age, exceeding 50% in 2007. Molecular studies were available in 95% of patients (286); 58% were Spanish and 42% were foreigners, of whom 54% were Romanians. The cluster percentage was 40%, with 30% of mixed clusters. According to conventional contact studies, 85% of patients in clusters had been considered isolated cases.Conclusions
The increased rate of tuberculosis in Castellón was mainly due to the increasing number of cases among foreigners, mostly Romanians. The availability of molecular studies in all patients with a positive culture allowed us to analyze how and where tuberculosis is transmitted in our province. Forty percent of the patients were grouped into clusters; of these, mixed clusters accounted for one third, indicating the high integration of immigrants in our area. 相似文献19.
Leonor Varela-Lema Gerardo Atienza MerinoMarisa López García María Vidal MartínezElena Gervas Triana Teresa Cerdá Mota 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(6):454
Objective
To explore perceptions of the use of health technology assessment (HTA) in the Galician public health system, identify opinions on the usefulness of the products and services developed by the Galician Health Technology Assessment Agency (avalia-t), and determine the barriers and facilitators to the transfer of results to clinical practice.Method
We performed a qualitative study based on in-depth semi-structured interviews of 20 intentionally selected experts (10 health care professionals and 10 hospital decision makers). The interviews were tape recorded and transcribed for inductive thematic analysis.Results
Interest in HTA activities was high, but most informants considered these activities to be underused as a tool to aid decision making in clinical practice. A series of key factors was identified to guarantee HTA use: greater dissemination of HTA activities and availability of the results, increased involvement and communication among health care professionals in the selection and prioritization of relevant research, contextualization and adaptation of results to the local context, increased organizational support and greater financial resources.Conclusions
The present study allows end-user? opinions on the utility of the various products/services offered by HTA agencies to be contrasted in order to adapt HTA activity to their needs and requirements. The involvement of health care professionals in all HTA fields is perceived as one of the main lines of action for HTA agencies. Such involvement could be achieved by reinforcing personal contact and increasing feedback to collaborators. 相似文献20.
Diana Gómez-Barroso Francisco Nogareda Rosa Cano Maria Fátima Pina José Luis Del BarrioFernando Simon 《Gaceta sanitaria / S.E.S.P.A.S》2011,25(4):290