Cronicidad y atención primaria: rol de la sanidad penitenciaria / Chronicity and primary care: the role of prison health

En Cataluña los Equipos de Atención Primaria Penitenciaria (EAPP) se han integrado en el Institut Català de la Salut (ICS). Esta integración facilitará la formación y actualización de los mismos, desaparecerán las diferencias existentes a nivel laboral entre servicios asistenciales pertenecientes a instituciones penitenciarias y los pertenecientes al Servei Català de la Salut. Permitirá el trabajo en equipo y la coordinación entre los EAP comunitarios y los (EAPP) de un mismo territorio compartiendo formación continuada, grupos de trabajo transversales y relación de base territorial, facilitando la continuidad asistencial y el abordaje integral e integrado de la cronicidad. Los sistemas de información existentes en Atención Primaria (AP) y la Historia clínica compartida de Cataluña son claves en este seguimiento. También se compartirán herramientas de soporte a la toma de decisiones clínicas, que contribuyen al aumento de calidad y seguridad clínica. Entre otras están las guías de práctica clínica electrónicas, guías terapéuticas, sistemas de alerta en prescripción, etc. Para los EAPP supondrá una oportunidad para introducirse en la docencia e investigación, que indirectamente repercutirá en la mejora de la calidad asistencial y de la formación de profesionales en este ámbito. La clave del éxito radicará en compartir un modelo único de atención a la cronicidad, donde se realicen actuaciones en promoción y prevención de la salud , seguimiento transversal de patologías y con la información asistencial compartida entre profesionales y niveles que a lo largo de la vida atiendan a la persona , este o no en el medio penitenciario (AU)

The Prison Primary Health Care Teams in Catalonia have been integrated into the Catalan Health Institute. This integration shall facilitate training and updating, while eliminating the existing differences between the health services belonging to prison institutions and those of the Catalan Health Service. It shall enable team work and coordination between Primary Health Care Teams in the community and the PHCTs in prisons within the same geographical area by sharing ongoing training, multi-sector work teams and territory-based relations, thereby facilitating continuance in care and complete and integrated treatment of chronicity. The existing information systems in Primary Health Care and the shared clinical history in Catalonia are key factors for this follow up process. Support tools for clinical decision making shall also be shared, which shall contribute towards an increase in quality and clinical safety. These tools include electronic clinical practice guides, therapeutic guides, prescription alert systems, etc. This shall be an opportunity for Prison Health Care Teams to engage in teaching and research, which in turn shall have an indirect effect on improvements in health care quality and the training of professionals in this sector. The critical factor for success is the fact that a unique chronicity health care model shall be shared, where measures for health promotion prevention can be taken, along with multi-sector monitoring of pathologies and with health care information shared between professionals and levels throughout the patient’s life, both in and out of the prison environment (AU)

Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case.

Black medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems - even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on 'do it yourself' strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents' level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.