[Recruitment, selection and retention staffing policies in health services directly managed. SESPAS Report 2024]. / Reclutamiento, selección y retención de profesionales en servicios de salud de gestión directa. Informe SESPAS 2024.

In an organization with highly specialized and changing services over the course of a working life, such as health services managed directly by public administrations (DM-NHS) are, the issues related to the recruitment, selection and retention of professionals should receive special attention. much larger than what is provided. For too long, the DM-NHS has mainly been working to resolve the problems that affect the organization, with enormous disregard for those suffer by the recipients of its services, the real population to which it provides assistance. In the DM-NHS, its administration (rather than management) of human resources is circumscribed by the contours of the Framework Statute and its implementing regulations and rulings. This is an inadequate instrument, both empirically in view of the results obtained (50% temporary employment among professionals working in the NHS), and conceptually, since it fails to comply with the reasons that normatively justify its existence: "that its legal regime is adapts to the specific characteristics of the practice of health professions, as well as the organizational peculiarities of the National Health System". The text describes the characteristics of statutory regulation and reviews how regulatory restrictions affect recruitment, selection and retention policies. Finally, possible alternatives are proposed to have coherent and rational permanent staffing policies that cover the real needs of the health services.

[Health policy priorities. SESPAS meeting at the XXXIII School of Public Health of Menorca]. / Prioridades de políticas de salud. Encuentro SESPAS en la XXXIII Escuela de Salud Pública de Menorca.

OBJECTIVE: In September 2022, the Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) brought together a panel of experts with the aim of defining and prioritizing health policy proposals, from the perspective of the Spanish State as a whole, to adapt the National Health System (NHS) to current risks and to contemporary/present-day society. METHOD: Expert meeting structured using a mix of procedures adapted from brainstorming, nominal group and Rand consensus method techniques. Relevance and feasibility of proposals identified were assessed individually by each panelist. Proposals were then ordered thematically and ranked according to the median and quartile deviation of relevance scores. RESULTS: Panelists identified and prioritized several proposals in different areas: governance and funding of the NHS, reform of the portfolio of services and benefits and of the NHS human resources, public health and health policy, actions against inequality and poverty, and healthcare delivery reform, including socio-sanitary, primary and end-of-life care. CONCLUSIONS: The results of the meeting show the urgent need to address in-depth changes in many state-wide health policies, including a major reconfiguration of governance, public health, and health care structures. They also point out potential areas of improvement, constituting a tentative guide of prioritized issues to be addressed.

Side effects during the week after first dose vaccination with four Covid-19 vaccines. Results of the ProVaVac Survey Study with 13,837 people in Spain.

BACKGROUND: In 2021, four vaccines against Covid-19 (BNT162b2, mRNA-1273, ChAdOx1nCoV-19, and JNJ-78436735) were employed in the region of Valencia, Spain. We conducted a survey to identify real-world, self-reported frequency and severity of side effects during the week after vaccination. METHODS: Survey data was obtained from April 19, 2021, to October 6, 2021, at three different moments in time: day one, day three and day seven after vaccination. Answers were linked to individual-level, personal and clinical information. Respondents were stratified by the vaccine they received and reported effects were presented over time and stratified by severity. We compared our results per vaccine with the frequencies stated in each Summary of Product Characteristics (SmPC). We used binomial logistic models to identify associations between respondent characteristics and side effects. RESULTS: No symptoms were reported by 1,986 respondents (14.35 %), 6,254 informed exclusively mild symptoms (45.20 %), 3,444 up to moderate symptoms (24.89 %), and 2,153 people (15.56 %) notified also severe symptoms. Among the latter, the more frequent were extreme tiredness (7.0 %), and nausea or vomiting (7.1 %). The reported frequency of facial paralysis (0.4 %) was much higher than reflected in SmPCs. Female sex, younger age, previous positive Active Infection Diagnostic Test, chronicity, and vaccination with other than the BNT162b2 vaccine were associated to an increased risk of side effects (p < 0.001). CONCLUSIONS: Side effects after vaccination are common in the real-world. However, they are principally mild, and their frequency declines after a few days. Providing patients with dependable, beforehand information about side effects may improve outcomes and reinforce vaccination programs.

[Evaluation of the launch of an unambiguous patient identification strategy in the hospitals of the Valencian Healthcare Agency (Spain)]. / Identificación inequívoca de pacientes. Evaluación del lanzamiento y su implantación en los hospitales de la Agencia Valenciana de Salud.

INTRODUCTION AND OBJECTIVE: Identification problems are associated with errors arising in the course of providing patient care. To improve patient safety, a universal and unambiguous identification system is required. The aim of this study was to assess the experience of designing, implementing and evaluating the launch of a strategy for unambiguous patient identification, using an identification bracelet in all the hospitals of the Valencian Healthcare Agency. METHOD: The assessment included the design of the identification material (bracelet) and its contents; the production, placement and identification of the bracelets, and the degree of implementation achieved at the launch of this strategy. RESULTS: The identification strategy was successfully implemented in a satisfactory proportion of sites (100% of the hospitals and 76% of hospital emergency departments within the first 24 hours of its functioning). Evaluation of the points defined as critical also showed high levels of compliance. Overall, the experience described could help the deployment of similar efforts in other centers and health services.

Reproducible research practices, openness and transparency in health economic evaluations: study protocol for a cross-sectional comparative analysis.

INTRODUCTION: There has been a growing awareness of the need for rigorously and transparent reported health research, to ensure the reproducibility of studies by future researchers. Health economic evaluations, the comparative analysis of alternative interventions in terms of their costs and consequences, have been promoted as an important tool to inform decision-making. The objective of this study will be to investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness and reproducibility. METHODS AND ANALYSIS: This is the study protocol for a cross-sectional comparative analysis. We registered the study protocol within the Open Science Framework (osf.io/gzaxr). We will evaluate a random sample of 600 cost-effectiveness analysis publications, a specific form of health economic evaluations, indexed in MEDLINE during 2012 (n=200), 2019 (n=200) and 2022 (n=200). We will include published papers written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years and/or disability-adjusted life years. Screening and selection of articles will be conducted by at least two researchers. Reproducible research practices, openness and transparency in each article will be extracted using a standardised data extraction form by multiple researchers, with a 33% random sample (n=200) extracted in duplicate. Information on general, methodological and reproducibility items will be reported, stratified by year, citation of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and journal. Risk ratios with 95% CIs will be calculated to represent changes in reporting between 2012-2019 and 2019-2022. ETHICS AND DISSEMINATION: Due to the nature of the proposed study, no ethical approval will be required. All data will be deposited in a cross-disciplinary public repository. It is anticipated the study findings could be relevant to a variety of audiences. Study findings will be disseminated at scientific conferences and published in peer-reviewed journals.

[Effectiveness, variation and inequalities. Hysterectomies and prostatectomies due to neoplasm in Spain (2002-2004)]. / Variabilidad, efectividad y desigualdad: Histerectomías y prostatectomías por enfermedad neoplásica en España (2002-2004).

BACKGROUND: Debates about equity in the utilization of health services often omit whether inequalities are observed in effective and safe procedures or they are experienced in treatments dubiously effective. This work tries to illustrate the difference between inequality and inequity in the health services research field. METHODS: Ecologic study on the standardized rates of surgical interventions in uterus and prostate cancer, produced between 2002 and 2004 in 180 healthcare areas in Spain. Socioeconomic variables: public beds per 100,000 inh, economic level, unemployment rate (population between 25 and 49), bank offices per 1,000 inh., and proportion of illiterate or persons with no studies. To estimate inequality statistics for Small Area Analysis were used; to determine the effect of socioeconomic factors, ANOVA and Linear Multiple Regression were modelled. RESULTS: 12,178 admissions for hysterectomy (2.19 per 10,000 women) and 13,416 prostatectomies (2.47 per 10,000 men) were analysed. All the statistics showed higher variation (inequality) in prostate cancer. Hysterectomy rates were not related with socioeconomic factors as oppose as prostatectomy: higher rates were related with living in areas with bigger centres (beta=0.89, p <0.001), with more economic level (beta=0.72, p=0.004) and less rate of illiterate persons (with regard to the tertile, betat2 = 0.75, p=0,002; betat3 = 0.57, p=0,044). CONCLUSION: Inequalities in the utilization of healthcare services do not necessarily imply inequity. In prostatectomy due to prostate cancer, an uncertain procedure in terms of effectiveness, the observed inequalities against poorer areas, should not be interpreted as a symptom of inequity.

Life medicalization and the recent appearance of "pharmaceuticalization".

Medicalization is a concern to which we have been paying attention intermittently for the past half century. However, it is increasingly  difficult to look away from its multiple and ubiquitous manifestations, and  therefore there is an increasingly higher number of analysis and studies about  them, from the most varied perspectives, not only by healthcare literature, but also with the great contribution by social sciences such as Anthropology or  Sociology.Based on previous publications, this article offers an updated review on life  medicalization in the European setting, highlighting particularly those situations  where a medication is the main vehicle for medicalization. This demands a  careful exploration of the "pharmaceuticalization" concept, which appeared in  the past decade, and which many of the research projects with these  characteristics intend to embrace.The decentralized nature of the decisions on diagnosis and treatment requires an agreement of healthcare professionals on the presumed benefits of certain  therapeutic interventions as key factor to the expansion of medicalization. Even  so, there are multiple interactions and synergies between incentives and  economic interests in the medicalization process, as well as bias in the  generation of knowledge, the training for professionals, their need to cope with  patient expectations, progressively overcoming their resolution capacities, and  the mechanisms for structuring said expectations. A better understanding of the  dispositifs that promote medicalization (the strategy without a strategist that  becomes visible through its cumulative outcome, but is less clearly seen by the  different agents, sometimes contradictory, working through it) is essential in  order to limit its most undesirable expansions.

La medicalización es una preocupación a la que prestamos atención intermitentemente desde hace medio siglo, pero cada vez resulta más difícil apartar la mirada de sus múltiples y ubicuas manifestaciones. Los análisis y estudios sobre este fenómeno son cada vez más abundantes y adoptan perspectivas más variadas, no solo desde la literatura de matriz  sanitaria sino también con importantes contribuciones de las ciencias sociales como la antropología o la sociología.A partir de trabajos previos se aporta una revisión actualizada sobre la medicalización de la vida en el entorno europeo, con especial énfasis en  aquellas situaciones en las que un medicamento es el principal vehículo de la  medicalización. Ese énfasis obliga a explorar atentamente el concepto de  "medicamentalización" surgido en la década pasada, y al que se pretenden  acoger muchas de las investigaciones de esas características.El carácter desconcentrado de las decisiones sobre diagnóstico y tratamiento exige para la extensión de la medicalización la anuencia de los  sanitarios sobre los beneficios de las intervenciones terapéuticas. Aun así,  en el proceso de medicalización las interacciones y sinergias son múltiples entre  los incentivos e intereses económicos, los sesgos en la producción del  conocimiento, la formación de los profesionales, su necesidad de lidiar con las  expectativas de los pacientes, progresivamente alejadas de las capacidades de  resolución de aquellos, y los mecanismos de conformación de dichas  expectativas. Una mejor comprensión de los dispositivos que propician la  medicalización ­la estrategia sin un estratega que se hace visible a través de su  resultado acumulativo, pero es vista con menos claridad por los diversos  agentes, a veces contradictorios, que trabajan a través de él­ resulta  imprescindible para limitar sus extensiones más indeseables.

[Barriers for introducing a health technology assessment organization to inform health care decision-making in the Spanish National Health System]. / Barreras a la introducción de una agencia evaluadora para informar la financiación o la desinversión de prestaciones sanitarias del Sistema Nacional de Salud.

BACKGROUND: To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). METHODS: Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. RESULTS: The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. CONCLUSION: Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.

[Pharmaceutical prescription in primary care. SESPAS report 2012]. / La prescripción farmacéutica en atención primaria. Informe SESPAS 2012.

In 2010, the Spanish National Health Service (NHS) paid for 958 million prescriptions. Given the massive population exposure to medication, the risks associated with drug consumption are highly significant from the perspective of public health. Areas requiring improvement in primary care prescription include overtreatment of patients in low risk situations, undertreatment of those in whom medication is indicated, poor patient information, polymedication, self-medication and the appreciable percentage of preventable adverse effects. Surprisingly, most of the pharmaceutical strategies in the NHS have not aimed to address these problems but have instead concentrated on reducing pharmaceutical expenditure, which is not a problem of pharmaceutical expenditure per se but is rather a consequence of "the problems" of prescription (and of the regulation and management of pharmaceutical services). Some key elements to improve this situation include more integrated healthcare, the development of electronic medical records systems, overall strategies to improve safety, and reducing the role of the pharmaceutical industry. Macro strategies include creating an agency able to objectively assess the additional value provided by a new drug and its additional cost, price fixing in line with cost-effectiveness, and exclusion of drugs with little or no added value from coverage, etc. Managing prescription involves the development of longitudinal patient care programs that incorporate clinical actions from different professionals, including whom to treat, how much to treat and how to treat.

[Transparency and good healthcare governance: an aid to overcoming the crisis]. / Transparencia y buen gobierno en sanidad. También para salir de la crisis.

Countries thrive on an economic foundation capable of facilitating the fulfillment of human potential in a society that does not renounce major achievements such as the welfare state. A necessary condition is that the "rules of the game", formal and informal institutions, make what is socially desirable individually attractive. Improving health governance, including its dimension of controlling corruption, and helping Spain out of the current economic crisis are two sides of the same coin. Characterization of health system governance in Spain and analysis of the impact of this governance on health policy, management of healthcare organizations and clinical practice allows an ambitious and feasible agenda to be drawn up of the remaining tasks that health professionals -broadly defined- and social actors should undertake with the support of citizens.

[Identification and prioritization of interventions to improve efficiency in the National Health System]. / Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud.

OBJECTIVES: To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government. MATERIAL AND METHODS: A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods. RESULTS: The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high. CONCLUSIONS: There are several opportunities to improve the efficiency of the Spanish NHS beyond the "anticrisis" measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.

[Public health crises in a developed society. Successes and limitations in Spain. SESPAS report 2010]. / Las crisis de salud pública en una sociedad desarrollada. Aciertos y limitaciones en España. Informe SESPAS 2010.

The perception, acceptability and management of risks are social construction. Consequently, in managing public health crises, the gap between facts, beliefs and feelings tests the responsiveness of official institutions to health alarms that can be objective, potential, or imaginary. On balance, a strong point of the Spanish experience of health crises is the presence of clinicians and public health officers working in an organization capable of responding adequately, although the quasi-federal Spanish political structure has both advantages and disadvantages. Weaknesses include the low profile given to public health and a management structure that relies too heavily on partitocracy. The management of these crises could be improved by transferring greater scope to health professionals in decisions about crisis identification and management (with transparency) and limiting bureaucratic inertia. For some, health crises involve visibility or business opportunities (not always legitimate). Therefore, the perception of crisis will increasingly rest less in the hands of experts and more in those of groups interested in spreading these crises or in providing solutions. While progress is needed to develop participation in strategies to respond to emerging crises, even more essential is the involvement of all healthcare levels in their preparation and dissemination.

[Pharmaceutical distribution and retail pharmacy]. / La distribución y dispensación de medicamentos.

In this chapter, the main characteristics of pharmaceutical distribution and retail pharmacy are described. The author analyses the structure of this sector, the agents operating in it -wholesalers, hospital pharmacy services and chemists- and the very few modifications introduced in it in the recent years, focusing on the incentives of its current structure and their consistency with health aims. On the basis of this analysis, the author outlines some possible ways to redefine the sector, which should focus on the promotion of desirable health objectives rather than on the survival of the inefficacies that hinder its evolution. The author pays special attention to the need to modify the inadequate existing retribution system and to substitute it for a different one, which focuses on the professionalism of the service provided, rather than on the profit margin or the sales.

Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital.

OBJECTIVES: To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies. DESIGN: Quasi-experimental pre-test/post-test with non-equivalent control group. SETTING: A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100,000. STUDY PARTICIPANTS: Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department). INTERVENTION: Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments. MAIN OUTCOME MEASURES: Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention. RESULTS: There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant. CONCLUSIONS: Providing physicians with feedback about percentage of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.