Accesibilidad y utilización de la espirometría en los centros de atención primaria de Cataluña

ObjectiveExamine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia.DesignCross-sectional study using a survey.ParticipantsThree hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010.MeasurementsSurvey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants.Main resultsResponse rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals. > 50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record. > 50% recognized a high priority strategies for improving the quality.ConclusionDespite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.     

Adaptación de los servicios de una organización de salud pública a la disminución de los recursos

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation.     

¿Gestión pública,privada o por el tercer sector? Diferencias en los resultados en atención primaria de Cataluña

GoalCompare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs.DesignMultidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals).LocalizationBarcelona, Catalonia, Spain.ParticipantsWe have 368 observations (primary health centers) and 18 indicators measured in 2015.InterventionDifferent management models (public, third sector, private).Main measuresWe compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching.ResultsSignificant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user.ConclusionsThe diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled.     

Responsabilidad por pérdida de oportunidad asistencial en patología oncológica maligna en la medicina pública española

ObjectiveThe loss of chance in healthcare has been forcibly introduced in the adjudications pronounced in recent years. Our objective was to analyse the verdicts of guilt resulting from the loss of chance ordered by the Contentious-Administrative Court (i.e., in the public healthcare system), in which both the origin of the disease to be treated and the sequelae were oncological processes.MethodWe analysed 137 cancer-related court judgments from the Contentious-Administrative Court, which referred to the concept of loss of chance, issued in Spain up to May 2014.ResultsOf the 137 sentences, 119 (86.9%), were pronounced due to diagnostic error and 14 (10.2%) due to inadequate treatment. Since 2010, 100 sentences have been passed (73.0%), representing an increase of more than 170% with respect to the 37 (27.0%) ordered in the first six years of the study (from 2004 to 2009). Most of the patients (68.6%) died, predominantly from breast cancer and gynaecological cancer (24.1%), and gastrointestinal cancers (21.1%). These malignancies were the ones most often involved in the sentences.ConclusionsThe litigant activity due to loss of chance in oncological processes in the public health care has significantly increased in the last years. The judgments were mainly given because of diagnostic error or inadequate treatment.     

Morbilidad metabólica en la población penitenciaria de Cataluña

ObjectiveTo investigate the prevalence of metabolic morbidity (MM) amongst prison inmates.DesignMulticentric, cross-sectional observational study.SettingAll (nine) prisons in Catalonia.ParticipantsConvicted inmates that are not in an «open regime», whose healthcare relies on the Prison Primary Care Teams.InterventionsMM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type 2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP).Main measurementsThe prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals.Results4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4 years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM.ConclusionsIn spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.     

Avanzando en la sistematización del benchmarking en servicios de salud pública

Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons.     

Participación pública en los proyectos de investigación: formas de crear conocimiento colectivo en salud

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results.     

Responsabilidad por pérdida de oportunidad asistencial en patologías neurológicas en la medicina pública española

Objective

To analyse the sentences due to loss of chance that were passed by the Contentious-Administrative Court (i.e., in public medicine), in which both the origin of the disease to be treated and the damages were neurological.

Las enfermedades crónicas como prioridad de la vigilancia de la salud pública en España

At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases.     

Colaboraciones interadministrativas en la gestión de la salud pública en municipios menores de 10.000 habitantes

This study analyses which administrative body local councils use to carry out their basic public health responsibilities. The study sample includes data from municipalities with less than 10,000 residents, which we believe is a first for studies published in academic journals in Spain. The data used was obtained by means of a survey administered by trained personnel. 93.7% of all the municipalities in the province of Girona, the area under study, responded to the survey. The analysis shows that there is a statistically significant difference between municipalities with more and less than 10,000 residents with regards to which administrative body local councils use for managing public health responsibilities. The results of this study suggest that in the ongoing debate over the streamlining of local government, the current situation regarding public health responsibilities in municipalities with less than 10,000 residents needs to be taken into account.     

Nuevos retos en gestión de vectores en salud pública: la mosca negra en Murcia (España)

Historically, no black fly (Diptera: Simuliidae) nuisance has been reported in the Murcia Region. Back in September 2016 the Ojós City Council has contacted the Regional Public Health General Directorate for help regarding a local insect nuisance, most probably based on mosquitoes. After sampling with a BG-sentinel 2 trap, collecting adult specimens with an entomological aspirator, and collect larvae and pupae on submerged giant cane stalks at the river, it turned out that Simulium sergenti was the insect species causing the nuisance. This species is not considered particularly anthropophilic; therefore, a low vector risk for human health was considered. However, the high fly density impaired the life quality of the people at the village. A management plan was recommended, treating the river with Bacillus thuringiensis var israelensis.