Criteria for implementing interventions to reduce health inequalities in primary care settings in European regions.

BACKGROUND: The current social and political context is generating socio-economic inequalities between and within countries, causing and widening health inequalities. The development and implementation of interventions in primary health care (PHC) settings seem unavoidable. Attempts have been made to draw up adequate criteria to guide and evaluate interventions but none for the specific case of PHC. This methodological article aims to contribute to this field by developing and testing a set of criteria for guiding and evaluating real-life interventions to reduce health inequalities in PHC settings in European regions. METHODS: A literature review, nominal group technique, survey and evaluation template were used to design and test a set of criteria. The questionnaire was answered by professionals in charge of 46 interventions carried out in 12 European countries, and collected detailed information about each intervention. Third-party experts scored the interventions using the set of evaluation criteria proposed. RESULTS: Nine criteria to guide and evaluate interventions were proposed: relevance, appropriateness, applicability, innovation, quality assurance, adequacy of resources, effectiveness in the process, effectiveness in results and mainstreaming. A working definition was drawn up for each one. These criteria were then used to evaluate the interventions identified. CONCLUSIONS: The set of criteria drawn up to guide the design, implementation and evaluation of interventions to reduce health inequalities in PHC will be a useful instrument to be applied to interventions under development for culturally, politically and socio-economically diverse PHC contexts throughout Europe.

[Advances of the investigation of "Ambulatory Care Sensitive Conditions" in primary care in Spain]. / Avances en España en la investigación con el indicador "Hospitalización por Enfermedades Sensibles a Cuidados de atención primaria".

Hospitalization due to ambulatory care sensitive conditions (ACSC) is an indicator of hospital activity that has demonstrated its usefulness as an indirect measurement of primary care effectiveness. Since this indicator was recently introduced in Spain, a collaborative effort between the different research groups could facilitate and promote its development and progress. The objective of this paper is to propose a working agenda that, starting from the most recent information, enhances the advance in this research field. The agenda includes the following sections: 1) To draw up specific ACSC lists for adult and pediatric population, as well as to look in greater depth into the concepts of, and differences in avoidable hospitalization and ACSC. 2) To complete the indicator validation process by assessing the external validity. 3) To propose, for future studies, the municipality as the unit of analysis, as well as to individualize the analysis of health conditions allowing for the differences between acute and chronic ones. 4) To adjust the indicators of hospital activity by hospital use index, when data from some hospitals are lacking and comparisons are wanted 5) To include a new variable, provider of primary health care services, in the Minimum Basic Data Set of Hospital Discharges. 6) To use this indicator as a measure of both the distribution of functions between levels of care and the coordination among them.

Sources of error and its control in studies on the diagnostic accuracy of "-omics" technologies.

Analyses of errors in diagnostic studies have led to improvements in the methodological quality of traditional laboratory research. However, since features of genomics and proteomics research ("-omics") differ from those of traditional research, sources of error are also likely to be distinct. We examine the main sources of error that are particularly relevant to "-omics"-based diagnostic techniques through the analysis of primary research papers which address these potential errors, their solutions, and the resulting spurious effect on diagnostic accuracy prediction. The main sources of error described in "-omics"-based research are mainly associated with chance: overfitting and inadequate sample size; variation: preanalytical variation (specimen collection and management), analytical variation (test procedures and reproducibility) and biological variation. We conclude that "-omics"-based research is prone to several errors. We have characterized them and shown the range of available solutions. This is a key step in the application of genomic discoveries to clinical and public health practice.

QUADOMICS: an adaptation of the Quality Assessment of Diagnostic Accuracy Assessment (QUADAS) for the evaluation of the methodological quality of studies on the diagnostic accuracy of '-omics'-based technologies.

OBJECTIVES: To adapt the Quality Assessment of Diagnostic Accuracy Assessment (QUADAS) to the particular methodological challenges posed by research on '-omics'-based diagnostic tests. DESIGN AND METHODS: We generated new guidelines by appraising the suitability of each criterion from QUADAS to '-omics'-based diagnostic research, and by adding new items that addressed specific sources of error. In addition, we defined four phases in the evaluation of a diagnostic test. RESULTS: Twelve of the 14 criteria from QUADAS were retained in the new tool. The items relating to selection criteria and the description of the test were reformulated, and the criteria about external validation and the availability of clinical data were applied only in studies in the last research phase. Four new items were incorporated to QUADOMICS related to pre-analytical conditions and methods to avoid overfitting. CONCLUSIONS: QUADOMICS is an adaptation of QUADAS to the special nature of '-omics'-based diagnostic research. The tool adds new items that assess quality issues specific to this research, and may enhance the application of '-omics'-based discoveries to clinical \and public health practice.

Physical and mental component summaries score of the SF-36 in coronary patients.

BACKGROUND: The aim of the study was to determine the clinical and sociodemographic factors related to the physical and mental components of the health-related quality of life (HRQL) in coronary patients. METHODS: We studied 132 patients diagnosed with Acute Myocardial Infarction (AMI) and unstable angina admitted to a cardiology unit over a period of 18 months. The HRQL was assessed with the Short Form 36 Health Questionnaire (SF-36) and the presence of possible mental disorders was measured using the General Health Questionnaire (GHQ-28). In order to study the variables related to both physical and mental summary components of the SF-36, two multiple linear regression models were constructed with the physical (PCS) and the mental component summary (MCS) as outcome variables. RESULTS: The GHQ-28 score > or = 6 was the variable most associated with the lowest PCS in the patients studied. Moreover in the patients with a personal history of coronary heart disease (CHD), age tended to increase the PCS of the HRQL, whereas in those with no such history, age diminished the PCS score. For the MCS, not being married, being of female sex, having GHQ-28 scores > or = 6 and being of younger age were the four variables most related to the lowest MCS score in the patients studied. CONCLUSION: Age, sex, marital status, personal history of CHD and the presence of a possible mental disorder were the factors most related to HRQL in the coronary patients studied. Focusing medical attention on these groups could contribute to improving their quality of life.

Avances en España en la investigación con el indicador 'hospitalización por enfermedades sensibles a cuidados de atención primaria' / Investigation Progress in Spain with 'Ambulatory Care Sensitive Conditions'

La hospitalización por enfermedades sensibles a cuidados de atención primaria es un indicador de actividad hospitalaria que ha demostrado su utilidad como medida indirecta de la efectividad de la atención primaria. El desarrollo de este indicador en España es relativamente reciente por lo que la colaboración entre los diferentes grupos de investigación podría facilitar y potenciar el progreso del mismo. El objetivo de este artículo es proponer una agenda de trabajo que, a partir de la información más reciente, permita avanzar en esta línea de investigación. La agenda de trabajo incluye los siguientes apartados: 1) Elaborar listados específicos para las poblaciones adulta y pediátrica, así como profundizar más en la separación de los conceptos de hospitalización evitable y enfermedad sensible a cuidados de atención primaria 2) Completar la validez del indicador con la realización del proceso de validación externa del mismo. 3) En los estudios posteriores se propone utilizar como unidad de análisis el municipio además de las unidades territoriales sanitarias básicas, y analizar patología por patología haciendo una diferenciación entre la aguda y la crónica.4) En el caso de que no se disponga de la información de todos los hospitales para el análisis de un determinado ámbito territorial y se pretenda comparar datos, se propone ajustar los indicadores de actividad hospitalaria por el índice de utilización.5) Incorporar la variable 'Proveedor de servicios de APS' en el CMBDAH. 6) Promover el uso de este indicador como medida del reparto de funciones entre niveles asistenciales y de la coordinación entre los mismos (AU)

Hospitalization due to ambulatory care sensitive conditions (ACSC) is an indicator of hospital activity that has demonstrated its usefulness as an indirect measurement of primary care effectiveness. Since this indicator was recently introduced in Spain, a collaborative effort between the different research groups could facilitate and promote its development and progress. The objective of this paper is to propose a working agenda that, starting from the most recent information, enhances the advance in this research field. The agenda includes the following sections: 1) To draw up specific ACSC lists for adult and pediatric population, as well as to look in greater depth into the concepts of, and differences in avoidable hospitalization and ACSC. 2) To complete the indicator validation process by assessing the external validity. 3) To propose, for future studies, the municipality as the unit of analysis, as well as to individualize the analysis of health conditions allowing for the differences between acute and chronic ones. 4) To adjust the indicators of hospital activity by hospital use index, when data from some hospitals are lacking and comparisons are wanted 5) To include a new variable, provider of primary health care services, in the Minimum Basic Data Set of Hospital Discharges. 6) To use this indicator as a measure of both the distribution of functions between levels of care and the coordination among them (AU)