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Sánchez Díaz M, Flórez Á, Carretero-Hernández G, Grau-Pérez M, García-Doval I, Carrascosa-Carrillo JM. Study of the impact of restrictions on access to biological drugs for the management of psoriasis on the Minimum Disease Activity criteria: subanalysis of AEDV EQUIDAD and AME projects. Actas Dermosifiliogr 2024:S0001-7310(24)00415-0. [PMID: 38768808 DOI: 10.1016/j.ad.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 05/22/2024] Open
Abstract
Spanish Autonomous Communities (ACs) are entitled to decide on the prescription requirements of their own territories, which can create inequalities in access to new drugs in the management of psoriasis. The objective of this study was to assess whether the level of restrictions in the access to new drugs for the management psoriasis was associated with the probability of achieving disease control measured using the Minimum Disease Activity (MDA) criteria. Therefore, we combined the results of 2 previous independent, cross-sectional studies: one that described the MDA in psoriasis by AC, and another that evaluated the level of restrictions to drug access by AC. We found that the higher the number of restrictions the lower the chances of achieving the MDA criteria (p = 0.013). Our results suggest that, in Spain, geographical differences in the access to new drugs may be creating health inequalities across the country.
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Affiliation(s)
- M Sánchez Díaz
- Becario Juan de Azúa, Unidad de Investigación. Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, Spain; Servicio de Dermatología. Hospital Universitario Virgen de las Nieves Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | - G Carretero-Hernández
- Servicio de Dermatología. Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - M Grau-Pérez
- Servicio de Dermatología. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Unidad de Investigación. Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, Spain
| | - I García-Doval
- Unidad de Investigación. Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, Spain; Servicio de Dermatología. Hospital do Meixoeiro, Vigo, Spain.
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2
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Sánchez-Díaz M, Flórez Á, Ara-Martín M, Arias-Santiago S, Botella-Estrada R, Cañueto J, Carretero-Hernández G, Coto-Segura P, de Eusebio-Murillo E, García-Latasa de Araníbar FJ, García-Patos Briones V, Gardeazabal García J, Gómez-Fernández C, Hernández-Ostiz S, Izu Belloso R, López-Ávila A, Manchado López P, Martín-Santiago A, Martinez de Espronceda Ezquerro I, Mateu-Puchades A, Mercader-García P, Notario Rosa J, Palacio Aller L, Pérez-Hortet C, Quintana-Castanedo L, Rivera R, Rocamora Duran V, Rodríguez-Nevado IM, Ruiz-Villaverde R, Suárez J, Trasobares-Marugán L, Vizán-de Uña C, Yanguas I, Zulaica-Garate A, García-Doval I, Descalzo MÁ, Grau-Pérez M, Carrascosa-Carrillo JM. [Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. Actas Dermosifiliogr 2024; 115:T237-T245. [PMID: 38242435 DOI: 10.1016/j.ad.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/09/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
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Affiliation(s)
- M Sánchez-Díaz
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, Spain; Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | - M Ara-Martín
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - R Botella-Estrada
- Servicio de Dermatología, Hospital Universitario La Fe, Valencia, Spain
| | - J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - G Carretero-Hernández
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Vital Alvarez-Buylla, Mieres, Asturias, Spain
| | - E de Eusebio-Murillo
- Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - V García-Patos Briones
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Gardeazabal García
- Servicio de Dermatología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - C Gómez-Fernández
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - S Hernández-Ostiz
- Servicio de Dermatología, Hospital de Calahorra, Calahorra, La Rioja, Spain
| | - R Izu Belloso
- Servicio de Dermatología, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - A López-Ávila
- Servicio de Dermatología, Hospital General Universitario Santa María del Rosell, Cartagena, Spain
| | - P Manchado López
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, Spain
| | | | - A Mateu-Puchades
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - J Notario Rosa
- Servicio de Dermatología, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - L Palacio Aller
- Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - C Pérez-Hortet
- Servicio de Dermatología, Hospital Universitario de Toledo, Toledo, Spain
| | - L Quintana-Castanedo
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Rocamora Duran
- Servicio de Dermatología, Hospital de Manacor, Manacor, Baleares, Spain
| | - I M Rodríguez-Nevado
- Servicio de Dermatología, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - J Suárez
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - L Trasobares-Marugán
- Servicio de Dermatología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - C Vizán-de Uña
- Servicio de Dermatología, Hospital Universitario de Cáceres, Cáceres, Spain
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, Spain
| | - A Zulaica-Garate
- Servicio de Dermatología, Hospital do Meixoeiro, Vigo, Pontevedra, Spain
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, Spain
| | - M Á Descalzo
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, Spain
| | - M Grau-Pérez
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, Spain; Servicio de Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - J M Carrascosa-Carrillo
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Sánchez-Díaz M, Flórez Á, Ara-Martín M, Arias-Santiago S, Botella-Estrada R, Cañueto J, Carretero-Hernández G, Coto-Segura P, de Eusebio-Murillo E, García-Latasa de Araníbar FJ, García-Patos Briones V, Gardeazabal García J, Gómez-Fernández C, Hernández-Ostiz S, Izu Belloso R, López-Ávila A, Manchado López P, Martín-Santiago A, Martinez de Espronceda Ezquerro I, Mateu-Puchades A, Mercader-García P, Notario Rosa J, Palacio Aller L, Pérez-Hortet C, Quintana-Castanedo L, Rivera R, Rocamora Duran V, Rodríguez-Nevado IM, Ruiz-Villaverde R, Suárez J, Trasobares-Marugán L, Vizán-de Uña C, Yanguas I, Zulaica-Garate A, García-Doval I, Descalzo MÁ, Grau-Pérez M, Carrascosa-Carrillo JM. Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. Actas Dermosifiliogr 2024; 115:237-245. [PMID: 37890617 DOI: 10.1016/j.ad.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
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Affiliation(s)
- M Sánchez-Díaz
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS, Granada, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, España
| | - M Ara-Martín
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS, Granada, España
| | - R Botella-Estrada
- Servicio de Dermatología, Hospital Universitario La Fe, Valencia, España
| | - J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - G Carretero-Hernández
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Vital Alvarez-Buylla, Mieres, Asturias, España
| | - E de Eusebio-Murillo
- Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - V García-Patos Briones
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Gardeazabal García
- Servicio de Dermatología, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - C Gómez-Fernández
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - S Hernández-Ostiz
- Servicio de Dermatología, Hospital de Calahorra, Calahorra, La Rioja, España
| | - R Izu Belloso
- Servicio de Dermatología, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - A López-Ávila
- Servicio de Dermatología, Hospital General Universitario Santa María del Rosell, Cartagena, España
| | - P Manchado López
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | | | - A Mateu-Puchades
- Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
| | | | - J Notario Rosa
- Servicio de Dermatología, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - L Palacio Aller
- Servicio de Dermatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - C Pérez-Hortet
- Servicio de Dermatología, Hospital Universitario de Toledo, Toledo, España
| | - L Quintana-Castanedo
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - V Rocamora Duran
- Servicio de Dermatología, Hospital de Manacor, Manacor, Baleares, España
| | - I M Rodríguez-Nevado
- Servicio de Dermatología, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - J Suárez
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - L Trasobares-Marugán
- Servicio de Dermatología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - C Vizán-de Uña
- Servicio de Dermatología, Hospital Universitario de Cáceres, Cáceres, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
| | - A Zulaica-Garate
- Servicio de Dermatología, Hospital do Meixoeiro, Vigo, Pontevedra, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, España
| | - M Á Descalzo
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, España
| | - M Grau-Pérez
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, España; Servicio de Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - J M Carrascosa-Carrillo
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
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Jiménez-Carrillo M, González-Rábago Y, González Miguel R, Baza Bueno M. [From face-to-face consultation to teleconsultation: Primary health care professionals' experiences in the Basque Country during the pandemic]. Aten Primaria 2023; 55:102702. [PMID: 37437478 PMCID: PMC10345852 DOI: 10.1016/j.aprim.2023.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DESIGN Qualitative exploratory research conducted between October and November, 2021. LOCATION Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. PARTICIPANTS Forty-six professionals from different categories of the PHC team and health centre directors. METHOD Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. RESULTS Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. CONCLUSIONS The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.
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Affiliation(s)
- Marta Jiménez-Carrillo
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, España.
| | - Yolanda González-Rábago
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España
| | - Raquel González Miguel
- OSI Donostialdea, Unidad de Atención Primaria Pasajes San Pedro-Bidebieta, Gipuzkoa, Bizkaia, España
| | - Mikel Baza Bueno
- Instituto de Investigación Sanitaria Biocruces Bizkaia, España; OSI Barrualde-Galdakao, Atención Primaria de Arrigorriaga, Bizkaia, España
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Gutiérrez Gutiérrez J, Carrasco González MD, Montiel González R, San Barón M, Barea Mendoza JA, Giménez-Esparza Vich C, Chico Fernández M, Martín Delgado MC. Challenges in intensive medicine: Diversity, equity and inclusion. Gender statement of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC). Med Intensiva 2023:S2173-5727(23)00059-0. [PMID: 37248094 DOI: 10.1016/j.medine.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023]
Abstract
Gender is a social determinant that impacts health and generates inequalities at all levels. It has impacts patients and critical conditions, health professionals and professional career development, and scientific societies from a perspective of social justice. All the International scientific societies of Intensive Care Medicine committed to contributing a gender perspective agree on the institutional need for achieving a formal positioning standpoint. The Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) is committed to ensuring the equality, inclusion and representativeness of its health professionals to fight the existing gender gap in the field of Intensive Medicine.
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Miranda-Malpica E, López-Cuéllar J. Cardiovascular disease risk in the transgender population. Arch Cardiol Mex 2023; 93:26-30. [PMID: 37992700 PMCID: PMC10665104 DOI: 10.24875/acm.m23000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023] Open
Abstract
This review summarizes the impact of gender affirming hormone therapy used in the transgendered population and the classic and emerging risk factors on cardiovascular outcomes and surrogate markers of cardiovascular health. There is a growing body of evidence that people who are transgender and gender diverse are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Previously, disparities have been reported in cardiovascular morbidity and mortality across this group as a result of a higher prevalence of non-healthy life style. However, recent research suggests that there are additional factors playing a role in this differences: there is the hypothesis that the excess of cardiovascular morbility and mortality has been driven by psychosocial stressors across the lifespan at multiple levels, as structural violence (e.g., discrimination, lack of affordable housing, lack of access to health care, etc.). Lack of information and research in this population is an important limitation; therefore, a multifaceted approach that integrates best practice into research, health promotion and cardiovascular care for this understudied and growing population is clearly needed.
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Ocaña Ortiz A, Peiró Pérez R, Gea Caballero V, Pérez Sanz E, Paredes-Carbonell JJ. [Entornos de Vida tool: innovation in participatory health analysis with an equity approach]. Gac Sanit 2022; 37:102245. [PMID: 36113322 DOI: 10.1016/j.gaceta.2022.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 10/14/2022]
Abstract
Municipal governments have the capacity to tackle the social determinants of health that play a role in their territories. The Valencian Community's local health action strategy promotes an intersectoral, participatory and equity-oriented approach to health inequalities affecting neighborhoods and municipalities across the region. To guide local health action, there is a need to adopt methodologies that capture community-based knowledge and experiences, encouraging community engagement at all stages. This article presents a methodology to carry out a local health needs assessment applying the Entornos de Vida tool. This tool enables the analysis of neighborhoods and municipalities through identifying how their characteristics have an impact on the health and well-being of their inhabitants.
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Affiliation(s)
- Ana Ocaña Ortiz
- Centro de Salud Pública de Gandía, Departamento de Salud de Gandía, Gandía (Valencia), España; Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Grupo PACAP (Programa de Actividades Comunitarias en Atención Primaria) de la Comunitat Valenciana, Societat Valenciana de Medicina Familiar i Comunitària (SoVaMFiC), Valencia, España; Facultad de Enfermería y Podología, Universitat de València, Valencia, España.
| | - Rosana Peiró Pérez
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Facultad de Enfermería y Podología, Universitat de València, Valencia, España; Oficina Valenciana d'Acció Comunitaria per a la Salut, Direcció General de Salut Pública i Addiccions, Generalitat Valenciana, Valencia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Vicente Gea Caballero
- Facultad de Ciencias de la Salud, Universidad Internacional de Valencia, Valencia, España; Grupo de Investigación en Salud Comunitaria y Cuidados SALCOM, Universidad Internacional de Valencia, Valencia, España
| | - Elena Pérez Sanz
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Departamento de Salud Pública de Valencia, Generalitat Valenciana, Valencia, España
| | - Joan Josep Paredes-Carbonell
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Grupo PACAP (Programa de Actividades Comunitarias en Atención Primaria) de la Comunitat Valenciana, Societat Valenciana de Medicina Familiar i Comunitària (SoVaMFiC), Valencia, España; Departamento de Salud de La Ribera, Generalitat Valenciana, Alzira (Valencia), España
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Ruiz-Hornillos J, Albert M, Real de Asua D, Herrera Abián M, de Miguel Beriain Í, Guillén-Navarro E. [Prioritization of health resources in contexts of scarcity. SESPAS Report 2022]. Gac Sanit 2022; 36 Suppl 1:S51-5. [PMID: 35781149 DOI: 10.1016/j.gaceta.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
La pandemia de COVID-19 ha supuesto un desafío tanto clínico como jurídico y bioético. Se desarrollan estos tres pilares fundamentales en el abordaje de la priorización de recursos sanitarios en pandemia: criterios clínicos, marco legal correspondiente y principios éticos aplicables. Inicialmente se aplicaron criterios clínicos para identificar a los pacientes con mejor pronóstico de supervivencia, combinando una evaluación clínica y el uso de variables de pronóstico a corto y largo plazo. Sin embargo, la decisión de priorizar la atención de un paciente sobre otro tiene una carga jurídico-política, que presenta el riesgo de caer en la discriminación ya que están en juego derechos fundamentales. Los criterios de priorización deben basarse en principios que reflejen como filosofía vehicular la que hemos asumido constitucionalmente como Estado social y democrático de Derecho, que no responde al utilitarismo, sino al personalismo. Cualquier filosofía de distribución de recursos tiene que tener presente la perspectiva científica, constitucional y, con ellas, las de los derechos fundamentales y los principios bioéticos. En la priorización de los recursos deberían consolidarse principios éticos como el respeto a la dignidad de las personas, el principio de necesidad (igual necesidad, igual acceso al recurso), el principio de equidad (que aconseja priorizar a los grupos de población más vulnerables), la transparencia (fundamental en la confianza de la sociedad) y el principio de reciprocidad (que exige proteger a los sectores de la población que asumen más riesgos), entre otros.
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Ocaña Ortiz A, Paredes-Carbonell JJ, Peiró Pérez R, Pérez Sanz E, Gea Caballero V. [Participatory evaluation in place-based communities: adaptating and validating the Place Standard tool to Spanish context]. Gac Sanit 2021; 36:360-367. [PMID: 33985841 DOI: 10.1016/j.gaceta.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Translation and cross-cultural adaptation to the Spanish context of the Place Standard tool to undertake participatory evaluations in place-based communities. METHOD A back-translation method was used to obtain an adapted version of the original Place Standard tool. The translated version was reviewed by a multidisciplinary committee of experts and validated using the Delphi method. RESULTS The final version of the adapted Place Standards tool (Entornos de Vida in Spanish) consists of 14 dimensions and 99 items. 21% of the items presented semantic difficulties during the translation. Total consensus through the Delphi panel was reached on 72% of the items. The analysis resulted in changes to the wording, and organization of the items, and the inclusion of new or modified questions to reflect the characteristics of the Spanish context. CONCLUSIONS The validation of the Entornos de Vida tool will enable the evaluation of place-based communities characteristics/physical and socio-economic contexts in a participatory and equitable manner that focuses on social determinants of health. Its application in scenarios that take into account processes of local health action will support the practice of health promotion and equity, and centre the attention and action on the physical and socio-economic contexts with the aim to learn how places and municipal policies can affect health and well-being.
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Affiliation(s)
- Ana Ocaña Ortiz
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Centro de Salud Pública de Gandía, Departamento de Salud de Gandía, Gandía, Valencia, España; Grupo PACAP (Programa de Actividades Comunitarias en Atención Primaria) de la Comunitat Valenciana, Societat Valenciana de Medicina Familiar i Comunitària (SoVaMFiC), Valencia, España; Departament d'Infermeria, Universitat de València, Valencia, España
| | - Joan Josep Paredes-Carbonell
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Grupo PACAP (Programa de Actividades Comunitarias en Atención Primaria) de la Comunitat Valenciana, Societat Valenciana de Medicina Familiar i Comunitària (SoVaMFiC), Valencia, España; Departamento de Salud de La Ribera, Alzira, Valencia, España.
| | - Rosana Peiró Pérez
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Departament d'Infermeria, Universitat de València, Valencia, España; Oficina Valenciana d'Acció Comunitaria per a la Salut, Direcció General de Salut Pública i Addiccions, Generalitat Valenciana, Valencia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Elena Pérez Sanz
- Grupo de investigación Acción Local y Equidad en Salud (ALES), Fundación FISABIO, Generalitat Valenciana, Valencia, España; Oficina Valenciana d'Acció Comunitaria per a la Salut, Direcció General de Salut Pública i Addiccions, Generalitat Valenciana, Valencia, España
| | - Vicente Gea Caballero
- Escuela de Enfermería La Fe, Centro Adscrito a la Universidad de Valencia, Valencia, España; Grupo de Investigación Arte y Ciencia del Cuidado (GREIACC), Instituto de Investigación Sanitaria La Fe, Valencia, España
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10
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Rodríguez-Feijoó S, Rodríguez-Caro A. [Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?]. Gac Sanit 2019; 35:138-144. [PMID: 31879054 DOI: 10.1016/j.gaceta.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/07/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. METHOD Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. RESULTS After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. CONCLUSIONS The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed.
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Affiliation(s)
- Santiago Rodríguez-Feijoó
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Alejandro Rodríguez-Caro
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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11
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Lletjós P, Continente X, Arechavala T, Fernández E, Schiaffino A, Pérez-Ríos M, López MJ. [Association between exposure to second-hand smoke and health status in children]. Gac Sanit 2018; 34:363-369. [PMID: 30558817 DOI: 10.1016/j.gaceta.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health. METHOD A cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level. RESULTS The prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children ≤5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed. CONCLUSIONS There are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented.
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Affiliation(s)
- Paula Lletjós
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica de Sant Pau, Barcelona, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España
| | - Teresa Arechavala
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España; Agència de Salut Pública de Barcelona, Barcelona, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España
| | - Esteve Fernández
- Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España; Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Anna Schiaffino
- Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España; Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Mónica Pérez-Ríos
- CIBER en Epidemiología y Salud Pública (CIBERESP), España; Dirección Xeral de Saúde Pública, Consellería de Sanidade, Santiago de Compostela (A Coruña), España; Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela (A Coruña), España
| | - María José López
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica de Sant Pau, Barcelona, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España.
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López Ruiz V, Segura Del Pozo J, Pires Gómez MP, Malmusi D, Vergara Duarte M, Pérez Sanz E. [Municipalism and community health: transforming through local government. SESPAS Report 2018]. Gac Sanit 2018; 32 Suppl 1:26-31. [PMID: 30268585 DOI: 10.1016/j.gaceta.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/28/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Municipalities and local government are an essential element to promote public policies that improve people's health, and impact the social determinants of health, through developing approaches which incorporate equity, community engagement and intersectoral partnership at their core. The objective of this article is to analyze the barriers and opportunities that can be encountered within local governments when interventions aimed at improving people's health are developed and implemented. The evolution of the city councils, their competence frameworks and the current socio-political context are described, and three key tools for local action are proposed: intersectorality, community engagement and working in partnership with other administrations. Global strategies such as the implementation of the "community health" and "health in all policies" approach through cross-sectoral networks/partnerships are described, emphasizing the importance of developing formal and informal structures or processes of community engagement and designing local health action plans in cooperation with other administrations, such as regional and national governing bodies. To continue supporting these forms of local governance, we propose adapting the local administrations to the new social realities, with more horizontal and flexible organization models and resource allocation, integrating efficiency and evaluation processes, reclaiming local autonomy, and building local governance through networks and alliances.
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Affiliation(s)
| | | | | | - Davide Malmusi
- Dirección de Servicios de Salud, Ayuntamiento de Barcelona, España; CIBER Epidemiología y Salud Pública
| | - Monserrat Vergara Duarte
- Concejalías de Salud Pública, Políticas de Igualdad, Solidaridad y Cooperación y Consumo, Ayuntamiento de Olesa de Monserrat (Barcelona), España; Unitat d'Avaluació, Sistemes d'Informació i Qualitat Assistencial, Gerència Territorial de Barcelona, Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Elena Pérez Sanz
- Oficina Valenciana de Acció Comunitaria per a la Salut (OVACS), Subdirecció General de Promoció de la Salut i Prevenció, Direcció General de Salut Pública, Valencia, España
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13
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Suárez Álvarez Ó, Fernández-Feito A, Vallina Crespo H, Aldasoro Unamuno E, Cofiño R. [Tools to assess the impact on health of public health programmes and community interventions from an equity perspective]. Gac Sanit 2018; 32:579-581. [PMID: 29759304 DOI: 10.1016/j.gaceta.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 11/26/2022]
Abstract
It is essential to develop a comprehensive approach to institutionally promoted interventions to assess their impact on health from the perspective of the social determinants of health and equity. Simple, adapted tools must be developed to carry out these assessments. The aim of this paper is to present two tools to assess the impact of programmes and community-based interventions on the social determinants of health. The first tool is intended to assess health programmes through interviews and analysis of information provided by the assessment team. The second tool, by means of online assessments of community-based interventions, also enables a report on inequality issues that includes recommendations for improvement. In addition to reducing health-related social inequities, the implementation of these tools can also help to improve the efficiency of public health interventions.
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Affiliation(s)
- Óscar Suárez Álvarez
- Observatorio de Salud en Asturias, Dirección General de Salud Pública, Consejería de Sanidad del Principado de Asturias, Oviedo, España.
| | - Ana Fernández-Feito
- Área de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, España
| | - Henar Vallina Crespo
- Área de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, España
| | | | - Rafael Cofiño
- Observatorio de Salud en Asturias, Dirección General de Salud Pública, Consejería de Sanidad del Principado de Asturias, Oviedo, España; Escuela Andaluza de Salud Pública, Granada, España
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14
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Díez E, Aviñó D, Paredes-Carbonell JJ, Segura J, Suárez Ó, Gerez MD, Pérez A, Daban F, Camprubí L. [A good investment: promoting health in cities and neighbourhoods]. Gac Sanit 2016; 30 Suppl 1:74-80. [PMID: 27837799 DOI: 10.1016/j.gaceta.2016.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/10/2016] [Accepted: 04/18/2016] [Indexed: 10/20/2022]
Abstract
Local administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies» and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.
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Abstract
The Department of Health of the Generalitat in Catalonia periodically draws up the Health Plan, which is the strategic document that brings together the reference framework for initiatives concerning public health in terms of the Catalan health administration. The 2011-2015 version of the Health Plan incorporates key care and system governance-related elements, which, in conjunction with health goals, make up the complete picture of what the health system in Catalonia should look like until 2015. The Plan was drawn up at a time when the environmental conditions were extremely particular, given the major economic crisis that began in 2007. This has meant that the system has been forced to address public health problems using a significant reduction in the economic resources available, while aiming to maintain the level of care provided, both quantitatively and qualitatively, and preserve the sustainability of the system whose defining traits are its universality, equity and the wide range of services on offer. The Health Plan focuses on three areas of action, 9 major courses of action and 32 strategic projects designed to respond to new social needs: addressing the most common health issues, comprehensive care for chronic patients and organizational modernization.
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16
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Urbanos-Garrido R. [Inequality in access to health care services. Policy recommendations aimed at achieving equity]. Gac Sanit 2016; 30 Suppl 1:25-30. [PMID: 27004770 DOI: 10.1016/j.gaceta.2016.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This article reveals the presence of inequalities in access to health care that may be considered unfair and avoidable. These inequalities are related to coverage of clinical needs, to the financial problems faced by families in completing medical treatments, or to disparities in waiting times and the use of services for equal need. A substantial proportion of inequalities appears to have increased as a result of the measures adopted to face the economic crisis. The recommendations aimed at improving equity affect different pillars of the taxpayer-funded health system, including, among others, the definition of the right to public health care coverage, the formulas of cost-sharing, the distribution of powers between primary and specialty care, the reforms of clinical management, and the production and dissemination of information to facilitate the decision-making processes of health authorities, professionals and citizens. Moreover, it is recommended to focus on particularly vulnerable population groups.
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Affiliation(s)
- Rosa Urbanos-Garrido
- Departamento de Economía Aplicada VI, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, España.
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17
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Fernández i Alegre R, Argenter i Giralt M, Rodríguez i Guasch X. [Sustainability and excellence of the Catalan health system. New paradigms, challenges and responses]. Med Clin (Barc) 2015; 145 Suppl 1:8-12. [PMID: 26711055 DOI: 10.1016/s0025-7753(15)30031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of a health system and the priority of any government is to anticipate problems before they appear, provide an innovative response to these new needs and healthcare models, improve access of the general public and patients to health care, especially care for the most vulnerable groups, improve healthcare results and implement the structural reforms necessary to maintain a viable and sustainable quality public healthcare system for everyone. In the current environment, health systems are facing new economic, demographic, care, social, technological and political paradigms to which health policy must respond. Faced with these challenges, health systems, especially in the case of Catalonia, are challenged to take decisions on how best to approach the implementation of structural reform designed to facilitate the necessary economic and fiscal sustainability in the service of fresh and innovative health policies and patient-centred care within a system marked by excellence and equity.
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Affiliation(s)
| | - Miquel Argenter i Giralt
- Dirección del Área de Recursos Económicos, Servei Català de la Salut (CatSalut), Departament de Salut, Generalitat de Catalunya
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18
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Urbanos Garrido R, Puig-Junoy J. [Austerity policies and changes in healthcare use patterns. SESPAS report 2014]. Gac Sanit 2015; 28 Suppl 1:81-8. [PMID: 24863998 DOI: 10.1016/j.gaceta.2014.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
Abstract
This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts.
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Affiliation(s)
- Rosa Urbanos Garrido
- Departamento de Economía Aplicada VI, Facultad de CC. Económicas y Empresariales, Universidad Complutense de Madrid, Madrid, España.
| | - Jaume Puig-Junoy
- Departament d'Economia i Empresa, Facultat de Ciències Econòmiques i Empresarials, i Centre de Recerca en Economia i Salud (CRES), Universitat Pompeu Fabra, Barcelona, España
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Cardona D, Acosta LD, Bertone CL. [Inequities in health among Latin American and Caribbean countries (2005-2010)]. Gac Sanit 2013; 27:292-7. [PMID: 23433772 DOI: 10.1016/j.gaceta.2012.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/12/2012] [Accepted: 12/05/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify health inequalities among Latin American and Caribbean countries in recent years (2005-2010), based on the view that measurement of inequalities is the first step in identifying health inequities. METHOD We performed an ecological study, whose units of analysis were 20 Latin American and Caribbean countries. These units were used to build the Inequalities in Health Index. This index summarizes, in a value ranging from 0 to 1, a set of socio-economic and health indicators, developed by international organizations. These indicators are considered as proximal and contextual determinants of health. RESULTS According to the index calculated, the five countries with the worst health status were Haiti, Guatemala, Bolivia, Venezuela and Honduras. In contrast, the five countries with the most favorable health status were Cuba, Argentina, Uruguay, Chile and Mexico. CONCLUSION Even today, there are wide health inequalities in Latin America and the Caribbean. The country with the most favorable health indicators was Cuba and that with the least favorable was Haiti. We recommend systematic evaluation of health inequalities in Latin America and the Caribbean through the Inequalities in Health Index and other indices, in order to analyze actions, policies and programs to reduce inequities in this region.
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