Spain: a decentralised health system in constant flux

The Spanish healthcare system is one of Europe’s most efficient, but urgent reform is needed if it is to cope with changing demands and rising costs, argue Jose M Martin-Moreno and colleagues

Relation between temperature and mortality in thirteen Spanish cities

In this study we examined the shape of the association between temperature and mortality in 13 Spanish cities representing a wide range of climatic and socio-demographic conditions. The temperature value linked with minimum mortality (MMT) and the slopes before and after the turning point (MMT) were calculated. Most cities showed a V-shaped temperature-mortality relationship. MMTs were generally higher in cities with warmer climates. Cold and heat effects also depended on climate: effects were greater in hotter cities but lesser in cities with higher variability. The effect of heat was greater than the effect of cold. The effect of cold and MMT was, in general, greater for cardio-respirator…

Distinguiendo entre «cita errónea» y plagio

Effectiveness of Safety Warnings in Atypical Antipsychotic Drugs

Studies conducted to obtain drug authorization are often of short duration and based on small sample sizes in selected populations. Policies on drug safety rely on the validity of the methods used to achieve rapid and effective communication of new information. No formal evaluation has ever been made of the Spanish communications system, although indirect data have raised questions about its effectiveness.To evaluate the impact of two safety warnings issued by the Spanish Drug Agency, and of a later prior authorization requirement involving the use of atypical antipsychotic drugs in the elderly.The study was based on a time-series analysis constructed with data corresponding to monthly invo…

Para salir del hoyo, lo primero es dejar de cavar

Entre los elementos que mejor configuran el entorno actual de la atencion sanitaria, en practicamente todos los paises desarrollados, la preocupacion de los gobiernos, las sociedades y la comunidad sanitaria por el crecimiento del gasto y la sostenibilidad de los sistemas de atencion de salud ocupa un lugar importante. En el caso del Sistema Nacional de Salud (SNS) espanol, enredado en la crisis economica y de legitimidad politica mas profunda y duradera que hayamos conocido desde la instauracion de la democracia, la inquietud por la sostenibilidad financiera ha adquirido carta de primer orden. En realidad, en muy poco tiempo hemos pasado del problema de la «sostenibilidad» al de «salvar lo…

La prescripción farmacéutica en atención primaria. Informe SESPAS 2012

ResumenEn 2010, el Sistema Nacional de Salud (SNS) facturó 958 millones de recetas. Dada la masiva exposición de la población a los medicamentos, los riesgos asociados a su consumo adquieren una enorme relevancia desde la perspectiva de salud pública. Pacientes sobremedicados en situaciones de bajo riesgo e inframedicados en situaciones de indicación demostrada, deficientemente informados, polimedicados, automedicados y un porcentaje no despreciable que sufre efectos adversos evitables, es en buena parte la fotografía de la prescripción en atención primaria que puede mejorarse. Sorprendentemente, la mayor parte de las estrategias farmacéuticas en el SNS no se han orientado al control de est…

The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study).

Purpose: To estimate the prevalence of vertebral fracture and densitometric osteoporosis in postmenopausal women over the age of 50 in Valencia, Spain. Methods: This cross-sectional study was conducted in 2006-2007. An age-stratified population-based random sample of 824 postmenopausal women over the age of 50 answered a questionnaire and received a densitometric examination of the lumbar spine and hip with dual-energy X-ray absorptiometry and a lateral X-ray of the thoracic spine and lumbar regions. Osteoporosis was defined as a T-score less than or equal to -2.5 compared to a population of young women, and the presence of vertebral fractures was classified according to Genant's semiquanti…

Caracterización de la suplementación de folatos en el embarazo a partir de la combinación de sistemas de información sanitaria.

ResumenObjetivosExplorar la utilidad de la combinación de los sistemas de información sanitaria de la Agencia Valenciana de Salud (AVS) para caracterizar la suplementación de folatos en la población de embarazadas de la Comunidad Valenciana.MétodosCohorte de todas las mujeres que parieron en hospitales de la AVS durante 2009, que fueron seguidas retrospectivamente en la historia clínica electrónica ABUCASIS y el sistema GAIA de gestión de la prescripción para identificar el consumo de folatos en los 3 meses previos y posteriores a la concepción.ResultadosDe los 38.069 partos realizados en 2009 en hospitales de la AVS, 37.040 (97,3%) pudieron incluirse en los análisis. Un 34,0% de las mujere…

Immunological response against SARS-CoV-2 following full-dose administration of Comirnaty® COVID-19 vaccine in nursing home residents

6 páginas, 2 figuras, 3 tablas. Se puede acceder al texto completo de este artículo desde PubMedCentral: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490129 . Los datos de investigación utilizados en el mismo, se encuentran disponibles en: https://doi.org/10.1016/j.cmi.2021.09.031.

La gestión sanitaria debe contribuir a reducir (no a incrementar) los problemas asociados a la prescripción inducida

Effectiveness of Organizational Interventions to Reduce Emergency Department Utilization: A Systematic Review

BackgroundEmergency department (ED) utilization has dramatically increased in developed countries over the last twenty years. Because it has been associated with adverse outcomes, increased costs, and an overload on the hospital organization, several policies have tried to curb this growing trend. The aim of this study is to systematically review the effectiveness of organizational interventions designed to reduce ED utilization.Methodology/principal findingsWe conducted electronic searches using free text and Medical Subject Headings on PubMed and The Cochrane Library to identify studies of ED visits, re-visits and mortality. We performed complementary searches of grey literature, manual s…

Burden of disease assessment with summary measures of population health for the Region of Valencia, Spain: a population-based study

Abstract Background and objective An important input to decision-making and health planning is a consistent and comparative description of the population health status. The purpose of this study was to describe the burden of disease in the Region of Valencia (Spain). Material and methods Disability-adjusted life years (DALYs) were calculated and divided into years of life lost (YLLs) and years lived with disability (YLDs). Using death registry data and Valencian population estimates in 2008, we calculated the number of deaths and YLLs. YLDs were based on age- and sex-specific data for countries of the EURO-A subregional level (which includes the Region of Valencia) from the Global Burden of…

PCV28 Control of Hypertension in Spain: A Systematic Review and Meta-Analysis of 76 Epidemiological Studies on 341,632 Participants

Prevalence of densitometric osteoporosis and osteopenia in Spain

Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperati…

Control of arterial hypertension in Spain

Hypertension is a leading global risk factor for the burden of cardiovascular disease. Data about changes in hypertension control are important to set intervention priorities. We conducted a systematic review and meta-analysis of epidemiological studies to determine the control of hypertension in Spain over the past decade.A search of PubMed/MEDLINE, SCOPUS and IME was performed for epidemiological studies conducted in Spain (since 2000) with data on control rates for hypertension. The primary outcome was the prevalence of uncontrolled hypertension defined as the percentage of patients having SBP at least 140 mmHg and/or DBP at least 90 mmHg. For populations at risk (e.g. patients with diab…

Variabilidad en la utilización de antihipertensivos entre las zonas básicas de salud de la Comunidad Valenciana

ResumenObjetivosEstimar el consumo de cinco subgrupos terapéuticos empleados en el tratamiento de la hipertensión arterial en las zonas básicas de salud (ZBS) de la Comunidad Valenciana, y analizar sus variaciones.MétodosEstudio ecológico, descriptivo, del consumo de antihipertensivos en las ZBS de la Comunidad Valenciana en el año 2005, seguido de análisis de la variabilidad observada. Se estudiaron las 239 ZBS existentes mediante un análisis descriptivo de consumo (dosis diarias definidas [DDD] por 1.000 habitantes y día en pensionistas [DDD/1.000p/día] o activos [DDD/1.000a/día]) y razones estandarizadas de utilización. Para el análisis de la variabilidad se utilizaron los estadísticos d…

A population-based screening for hepatitis C antibodies and active infection using a point-of-care test in a low prevalence area

Background Data on the true prevalence of hepatitis C virus (HCV) infection in the general population is essential. We evaluated a program implementing free universal HCV screening using a non-invasive point-of-care test (POCT) (OraQuick-HCV rapid test) in oral fluid in an urban area in Valencia, South-Eastern Spain. Methods A cross-sectional study was performed during 2015–2017. Free HCV screening was offered by regular mail to 11,500 individuals aged 18 and over, randomly selected from all census residents in the Health Department. All responding participants filled in a questionnaire about HCV infection risk factors and were tested in their tertiary Hospital. In those with a positive POC…

Association of Vitamin K and Non-Vitamin K Oral Anticoagulant Use and Cancer Incidence in Atrial Fibrillation Patients

The association between the use of vitamin K antagonists (VKAs) and cancer risk reduction remains unclear. We aimed to assess the association between the use of VKAs or direct oral anticoagulants (DOACs) and the incidence of cancer in a large cohort of patients with atrial fibrillation (AF) by means of a population-based, propensity-weighted cohort study using population-wide databases including patients diagnosed with nonvalvular AF (NVAF) followed for up of 5 years (median 2.94 years). We created two cohorts based on the initiation therapy (VKA or DOAC). Initiation with VKA or DOAC was defined as filling a prescription with no previous exposure in the preceding 12 months. Cancer diagnoses…

Cirugía de liberación del túnel carpiano: variabilidad e impacto de la cirugía ambulatoria en la Comunidad Valenciana

Objective: This study aimed to analyze variability in rates of carpal tunnel release surgery among the healthcare areas of the autonomous region of Valencia, and to evaluate the contribution of ambulatory surgery and referrals to private hospitals to the variability found. Methods: We carried out a cross-sectional, population-based study, describing the rates of carpal tunnel release surgery, standardized by age and sex, among areas in the region of Valencia in 2006. The observed variation was then analyzed using small-area analysis methods. Data from hospital admissions, referrals to private hospitals, population statistics and hospital resources were used to construct standardized rates, …

Additional file 1: of The quality of reporting methods and results of cost-effectiveness analyses in Spain: a methodological systematic review

Reporting methods and results of CEA Spain_annex. Table S1. PubMed/MEDLINE search strategy. Table S2. Included studies. Table S3. PRISMA Checklist. Figure S1. Flow diagram for study selection. Figure S2. Growth in published cost-effectiveness analyses. Spain, 1989-2014.

Mito y realidad en las diferencias de resultados en bachillerato y en la prueba de acceso a la universidad de los centros públicos y privados en Asturias en el período 2004-2008

En la presente investigación se realizan análisis cuantitativos para establecer las posibles diferencias entre los resultados de todos los centros -públicos y privados-, obtenidos en el bachillerato y en la Prueba de Acceso a la Universidad (PAU) por la totalidad del alumnado que se presentó a las PAU, en Asturias, entre los años 2004 y 2008. Se concluye que, efectivamente, existen diferencias de resultados, diferencias entre asignaturas (departamentos) y entre centros. Se plantean hipótesis de trabajo sobre las diferencias intracentro e intercentro, más allá de la dualidad público-privado.

Coauthorship and institutional collaborations on cost-effectiveness analyses: a systematic network analysis

BackgroundCost-Effectiveness Analysis (CEA) has been promoted as an important research methodology for determining the efficiency of healthcare technology and guiding medical decision-making. Our aim was to characterize the collaborative patterns of CEA conducted over the past two decades in Spain.Methods and findingsA systematic analysis was carried out with the information obtained through an updated comprehensive literature review and from reports of health technology assessment agencies. We identified CEAs with outcomes expressed as a time-based summary measure of population health (e.g. quality-adjusted life-years or disability-adjusted life-years), conducted in Spain and published bet…

Carpal tunnel release surgery: small-area variation and impact of ambulatory surgery in the autonomous region of Valencia, Spain

Objective: This study aimed to analyze variability in rates of carpal tunnel release surgery among the healthcare areas of the autonomous region of Valencia, and to evaluate the contribution of ambulatory surgery and referrals to private hospitals to the variability found. Methods: We carried out a cross-sectional, population-based study, describing the rates of carpal tunnel release surgery, standardized by age and sex, among areas in the region of Valencia in 2006. The observed variation was then analyzed using small-area analysis methods. Data from hospital admissions, referrals to private hospitals, population statistics and hospital resources were used to construct standardized rates, …

PCV71 Sponsorship and Pharmacoeconomic Conclusions of Studies on Statin Use for Cardiovascular Prevention: A Systematic Analysis

Crisis económica y epicrisis del sistema sanitario

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a bod…

A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management.

Abstract Background The aim of this study was to develop a risk score system for identification of patients with upper-GI hemorrhage who are suitable for outpatient management. Methods From a prospective cohort of 983 consecutive patients with upper-GI hemorrhage not associated with portal hypertension, 581 cases that did not meet pre-established criteria for admission were selected, and a logistic regression analysis was performed to identify factors associated with two adverse outcomes: recurrent bleeding and/or the need for emergency surgery. The risk score system was developed by using the beta coefficients of the logistic model, and its performance was evaluated. The results of this mo…

Variabilidad en la utilización de los servicios de urgencias hospitalarios del Sistema Nacional de Salud

ResumenObjetivoLos objetivos de este estudio fueron estimar las tasas de frecuentación a los servicios de urgencias hospitalarios (SUH) del Sistema Nacional de Salud (SNS) por áreas de salud, el porcentaje de ingresos, las razones estandarizadas de utilización de urgencias y analizar la relación con los recursos hospitalarios.MétodosEstudio ecológico combinando información de diversas fuentes (Encuesta de Establecimientos Sanitarios con Régimen de Internado 2006 y Conjunto Mínimo de Datos Básicos 2006) para estimar la frecuentación a los SUH y el porcentaje de ingresos asociado en 164 áreas de salud de 14 comunidades autónomas (CC.AA.).ResultadosLos 35,3 millones de habitantes de las 164 ár…

A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: The air-test score

BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs. METHODS: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial …

Dispensación personalizada de medicamentos en las oficinas de farmacia: ¿una medida basada en la evidencia?

Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud

ResumenObjetivosIdentificar un número significativo de actuaciones orientadas a mejorar la eficiencia y reducir el despilfarro en el Sistema Nacional de Salud (SNS), y priorizarlas en función de su impacto. Valorar el impacto y la prioridad de las medidas implantadas o anunciadas por el gobierno.Material y métodosReunión de 13 expertos, estructurada siguiendo procedimientos adaptados de las técnicas de brainstorming, grupo nominal y método de consenso Rand.ResultadosEl panel propuso 101 posibles medidas para mejorar la eficiencia del SNS, que junto a las 11 contenidas en los Reales Decretos-Ley 4 y 8 de 2010, suman un total de 112 propuestas valoradas. Las propuestas se centraron en el buen…

The quality of reporting methods and results of cost-effectiveness analyses in Spain: a methodological systematic review

Open Access; Open Peer Review.-- et al.

Global health priorities and research funding

Sesgos territoriales en la mortalidad hospitalaria estimada por la encuesta de morbilidad hospitalaria

Fundamentos. La Encuesta de Morbilidad Hospitalaria (EMH) incorpora actualmente el 85% de los hospitales y el 90% de las altas, y es la única fuente de ámbito estatal que permite profundizar, con información sobre diagnóstico, edad o género, en el estudio del hospital como lugar de fallecimiento. El objetivo de este trabajo es analizar la posible presencia de sesgos territoriales en la mortalidad hospitalaria recogida en la EMH respecto al universo muestral que supone la Estadística de Establecimientos Sanitarios con Régimen de Internado (EESCRI). Métodos. Se contrastó, para cada provincia y en 2004, las estimaciones de altas, fallecidos y porcentaje de mortalidad de la EMH con los datos de…

Impact of osteoporosis and vertebral fractures on quality-of-life. a population-based study in Valencia, Spain (The FRAVO Study)

Abstract Background To describe the health related quality of life in a population sample of postmenopausal women over the age of 50 and resident in the city of Valencia (Spain), according to the presence/absence of osteoporosis and the severity of prevalent morphometric vertebral fractures. Methods A cross-sectional age-stratified population-based sample of 804 postmenopausal women of 50 years of age and older were assessed with the SF-12 questionnaire. Information about demographic features, lifestyle, clinical features, educational level, anti-osteoporotic and other treatments, comorbidities and risk factors for osteoporosis were collected using an interviewer-administered questionnaire …

Atlas of Variations in Medical Practice in Spain: The Spanish National Health Service under scrutiny

Early in the 2000s, a countrywide health services research initiative was launched under the acronym of Atlas VPM: Atlas of Variations in Medical Practice in the Spanish National Health System. This initiative aimed at describing systematic and unwarranted variations in medical practice at geographic level-building upon the seminal experience of the Dartmouth Atlas of Health Care. The paper aims at explaining the Spanish Atlas experience, built upon the pioneer Dartmouth inspiration. A few selected examples will be used along the following sections to illustrate the outlined conceptual framework, the different factors that may affect variation, and some methodological challenges.

The influence of apo E phenotypes on the plasma triglycerides response to hormonal replacement therapy during the menopause

Objective: To study the influence of apo E phenotype in plasma lipids, especially in triglycerides levels, in menopausal women receiving hormonal replacement therapy (HRT). Methods: One hundred and ten postmenopausal women were studied. Plasma total cholesterol (TC), HDL-C and triglycerides (TG) were measured before and after 3 months of HRT and the apo E phenotype was determined. According to the apo E phenotype the sample was divided into three groups: E2/E3 (n=28), E3/E3 (n=96) and E4/E3 (n=25). Results: In the pre-treatment state, higher plasma levels of TC and TC/HDL-C ratio were observed in women with phenotype E3/E4 (P<0.0001 and P<0.02, respectively), while higher plasma TG levels w…

PHP79 What Are the Research Priorities in the Spanish National Health System? A Comparison of Economic Evaluations of Health Care Interventions and Public-Funded Research

Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System

Background Little is known about the real1world characteristics of asthma patients with exacerbations or their pharmacotherapeutic management. We described the sociodemographic and clinical characteristics, and the patterns of short and long-term management of asthma attacks, in a population-wide cohort of exacerbators in the region of Valencia, Spain. Methods We selected asthma patients with at least one exacerbation in 2015 and 2016, we classified them according to their patterns of exacerbations in the 4 years previous to the index exacerbation and their therapeutic step at baseline based on medication received in the previous year. We described the short and long-term pharmacological ma…

PHP7 Orphan Drugs for Rare Diseases in the European Union: Bridging the Gap between Drug Development and Unmet Medical Needs?

Prevalence of attention deficit hyperactivity disorder among children and adolescents in Spain: a systematic review and meta-analysis of epidemiological studies

Abstract Background Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed neuropsychiatric disorder in childhood, but the frequency of the condition is not well established in many countries. The aim of the present study was to quantify the overall prevalence of ADHD among children and adolescents in Spain by means of a systematic review and meta-analysis. Methods PubMed/MEDLINE, IME, IBECS and TESEO were comprehensively searched. Original reports were selected if they provided data on prevalence estimates of ADHD among people under 18 years old in Spain and were cross-sectional, observational epidemiological studies. Information from included studies was systematically ex…

The appropriateness of colonoscopies at a teaching hospital: magnitude, associated factors, and comparison of EPAGE and EPAGE-II criteria.

Background The growing demand for colonoscopies and inappropriate colonoscopies have become a significant problem for health care. Objectives To assess the appropriateness of colonoscopies and to analyze the association with some clinical and organizational factors. To compare the results of the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) and the EPAGE-II criteria. Design Cross-sectional study. Setting Endoscopy unit of a teaching hospital in Spain. Patients Patients referred for colonoscopy, excluding urgent, therapeutic indications, and poor cleansing. Main Outcome Measurements Appropriateness of colonoscopies according to the EPAGE criteria. Results From 749 c…