Technology evaluation of a USA-Mexico health information system for epidemiological surveillance of Mexican migrant workers

From 1994 through 1996, federal, state, and nongovernmental organizations in Mexico and in the United States of America developed and piloted a Binational Health Information System for Epidemiological Surveillance of Mexican migrant workers. The system allowed data exchange for epidemiological surveillance between the state of Guanajuato in Mexico and the Commonwealth (state) of Pennsylvania in the United States, for case detection, prevention, and treatment, through shared contact investigation and case management of communicable diseases. The target population consisted of migrant workers traveling between Guanajuato and Pennsylvania to work mainly in the mushroom industry, and their sexual partners in their Mexican communities of origin. Computerized migrant health information modules were set up in Guanajuato and in Pennsylvania. Patient information and epidemiological surveillance data were encrypted and communicated electronically between the modules, using the WONDER communications system of the U.S. Centers for Disease Control and Prevention. Evaluation of the Guanajuato-Pennsylvania Binational Health Information System showed that major barriers to binational epidemiological surveillance and control are: a)lack of communication binationally; b) interrupted medical care due to migration; c) inconsistent diagnosis and treatment criteria between the two countries; d) lack of referral clinical records from one country to the other; and e) deficient legal regulations concerning binational clinical data transfer. To our knowledge, this is the first project that has successfully demonstrated the technological feasibility of a binational disease control system linking a state in the interior of one country with a state in the interior of another country, rather than just states in the border region. The project also advanced the understanding of health service organizational issues that facilitate or hinder communication, outreach, disease prevention, and organization of health care services for migrant workers in both Mexico and the United States. Despite the unprecedented success and potential bilateral benefits demonstrated by this project, serious structural and organizational deficits in the public health systems of both countries muest be addressed before epidemiological seurveillance can be achieved binationally

Farmacoeconomía: evaluación científica o estrategia comercial? / Pharmacoeconomics: scientific assessment or commercial strategy?

The new global context, the dramatic rise in the cost of many health technologies, and the mounting pressures that constrain health sector budgets in most countries have created the need to evaluate health interventions, including pharmaceuticals, from an economic perspective. Pharmacoeconomics is "the application of economic theory to pharmacotherapeutics" and is often linked to commercial marketing. We propose standardizing the various methods of economic analysis so as to allow for comparisons and assessment of correct relationships. The author concludes pharmacoeconomics is simply an analytical fool that can be applied for scientific assessment or commercial promotion, depending on the objectives and purpose for which the use of this new discipline is intended

Evaluación de la tecnología empleada en la atención de la salud / Assessment of health care technology

This report explains how and why to evaluate the technology employed in health care. This technology includes not only medicines, instruments, equipment, and procedures used directly on patients, but also the organizational models and support systems that make health care possible. During the various stages of a technology's life cycle, an assessment is made of several different characteristics, such as safety and effectiveness, clinical utility, economic impact, and effect on the organization and provision of services. Originally, the ways of assessing and testing technical methods were only of interest ot manufacturers and service providers. Today, however, the interested parties include legislators, government officials, health administrators, researchers, industrial managers, and, certainly, patients and their families. Therefore, health technology assessment is a highly important activity and its promotion is an element of PAHO's technical cooperation with the Member States

La evaluación del desempeño para la educación permanente del equipo local de salud: prueba de campo metodológica en el Canton de Pérez Zeledon, Costa Rica / Performance evaluation for continuing education of health staff

El PASCAP propuso en 1990 una metodología para evaluar el desempeño del equipo local de salud, con el propósito de ofrecer insumos para identificar necesidades de capacitación en los procesos de educación permanente. El diseño se sustentó en la reflexión del equipo local de salud sobre la equidad, la eficiencia y la eficacia del trabajo en salud en un área geográfica determinada y en relación con las necesidades de salud de los grupos humanos de mayor riesgo relativo de enfrentar y morir. Esta propuesta metodológica tuvo una prueba de campo en 1991 en un cantón de la República de Costa Rica, Centro América. Ella es el tema del presente artículo