[Independent evaluation of the COVID-19 crisis. Lessons to be learned]. / Evaluación independiente de la crisis de la COVID-19. Lecciones por aprender.

The independent evaluation report on the performance of the National Health System in the face of the COVID crisis is rigorous, well thought out and well executed. It has benefited from the participation of numerous experts and institutions. The altruistic effort of the coordinators and hundreds of experts, professionals and citizens is noteworthy, which does not justify the asymmetry between "everything for free" when it comes to shared intelligence, and market prices when it comes to commissioning reports from consultancy firms that are sometimes not worth the cost. The valuable work has suffered from unexplained delays and delayed dissemination that do not bode well for whether there is interest in learning from the pandemic or leaving it behind and forgetting it. Indeed, valuable reports provided by the public administration itself (listed in the report) have still not been made public, despite the request of the coordinators. However, the mere fact that the evaluation has been carried out under the influence and pressure of scientists and professionals should encourage the actions of civil society organisations. Advocacy is needed to ensure that public administrations see collective intelligence as an invaluable resource to be nurtured and stimulated. Regular accountability of executive powers at all levels needs to be pursued vigorously. Many sensible proposals to improve healthcare have been ignored, but we learned that achievements are made with perseverance. It is not an option, it is part of the core business of public health.

[Experiences in human resources planning for health: The case of physicians. Data and models. SESPAS Report 2024]. / Experiencias de planificación de recursos humanos para la salud. El caso de los médicos. Datos y modelos. Informe SESPAS 2024.

Virtually all developed countries conduct physician planning exercises. We can learn from successful experiences. The modeling and projection of supply is technically complex, but it is a technical matter, whereas the assessment of demand or need, and therefore the outcome in terms of deficit or surplus, requires standards, usually in population ratios, which are based on expert judgments and belong to the normative universe. One type of technical problem insufficiently solved is that of converting "heads" into full time equivalents. Fortunately, progress is being made in the right direction. We need more and better information, in particular the State Register of Health Professionals, but even with the limitations of the data, it is necessary to plan. The Ministry of Health, the Autonomous Regions and other professional and union organizations regularly carry out planning exercises. We have high rates of physicians and graduates, and low rates of nurses, a growing number of physicians in both public and private practice, and short-term deficits in some specialties, particularly family medicine, which urgently needs specific incentives to stimulate vocations. The numbers tell only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but rather by reforming the regulatory framework, incentive systems and public management slack to compete with the private sector in attracting and retaining talent.

[What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. SESPAS Report 2024]. / ¿Qué sabemos y qué deberíamos saber sobre los desequilibrios de médicos en España? Diagnóstico y propuestas. Informe SESPAS 2024.

This article characterizes the main features of the supply, demand, and labor markets for physicians in Spain, with an international and territorial perspective. It also presents some of the results of the simulation model for specialist physicians with a 2035 horizon and proposes strategic and short-term lines of action in the planning, regulation, and management of health professionals in Spain, with a focus on specialist physicians. In Spain there are high rates of physicians and medical graduates, but low rates of nurses, compared to other developed countries. Approximately 30% of practicing physicians (not considering residents) practice only in the private network. In the last two decades, competition from the private sector for health professionals has intensified, competing with the public network, which is subject to an excessively rigid regulatory framework. There is currently a shortage of physicians in some specialties, particularly in family medicine, which urgently needs specific incentives to stimulate vocations. Numbers consider only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but by reforming the regulatory framework, the incentive systems, and the slack in public management to compete with the private sector in attracting and retaining talent.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview.

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

Socioeconomic and contextual determinants of the burden of disease attributable to metabolic risks in childhood.

We analyze the socioeconomic and political contextual determinants of the burden of disease attributable to three metabolic risks in children: kidney dysfunction, high fasting plasma glucose, and high body-mass index. We use data from 121 countries. We matched data of the Global Burden of Disease project, World Bank and United Nations databases. The burden of disease is measured with the Disability Adjusted Life Years lost. We explore associations with four groups of variables: (i) income level, which measures differences in socioeconomic conditions between countries; (ii) income inequality, which measures within country inequalities in the income distribution; (iii) health care expenditure, which measures the resources allocated to health and healthcare, and (iv) women empowerment, which we measure in terms of both educational and political participation. Our findings point toward the need to act at the root of the underlying factors underpinning the disease burden, namely: reducing between and, particularly, within-country income inequalities, increasing the role of expenditure on health, and ensuring women empowerment and girls education. To our knowledge, this is the first study that have identified the associations of these variables with the burden of disease that is specifically attributable to metabolic risks in childhood.

Nursing Homes: Affiliation to Large Chains, Quality and Public-Private Collaboration.

The objective of this paper was to estimate the influence of being affiliated with an NH chain on perceived consumer quality, and whether this relationship is affected by maintaining a collaboration agreement with public administrations. We used a combination of theoretical foundations: (1) From the consumer perspective, we focussed on online reviews of the quality of nursing homes (NHs); (2) from the industrial organisation literature, we proposed arguments regarding the advantages and disadvantages of belonging to a chain; (3) the theory of transaction costs was used to explain public-private collaboration. The study was carried out on a sample of 642 chain-affiliated Spanish NHs, with data from quality scores downloaded from the website topMayores.es. We distinguished between the six largest chains and the rest. We applied linear regression models. The results show that NHs affiliated with one of the largest NH chains obtained worse quality scores in the assessment made by users, although quality scores improved for the largest chains of NHs involved in an agreement with the public administration.

[Rebuilding the healthcare system: governance, organization and digitalization. SESPAS Report 2022]. / Reconstrucción del sistema sanitario: gobernanza, organización y digitalización. Informe SESPAS 2022.

Reflection on three major levers for rebuilding the healthcare system: governance, integration of health and social care and digitalization. Spain has worrying levels of quality of democracy and public confidence in its politicians, and major changes are required in public administration to achieve a better state. Healthcare suffers from a deficient institutional architecture that prevents adequate macrogovernance. There is also a lack of autonomy in the management of public health centers, which hinders competition by comparison, care integration and coordination within and between levels of care. The pandemic has highlighted the value of professionalism and has shown that agile healthcare management is possible, but the challenge is to maintain this flexibility outside state of alarm. Care integration is more necessary as the population ages (albeit healthily), and per capita financing is a powerful tool to achieve it. Digitization concerns practically all areas of healthcare and population health, and will bring with it far-reaching organizational changes, requiring new methods of evaluation that differ according to the degree of intrusiveness in individual health. Telemedicine, sponsored during the pandemic with a view to permanence, induces changes in labor relations, among others. It is necessary to measure the value of digital tools and technologies. Spain has a unique opportunity for its digital transformation, thanks to European funds.

Health alliance for prudent prescribing and yield of antibiotics in a patient-centred perspective (HAPPY PATIENT): a before-and-after intervention and implementation study protocol.

BACKGROUND: Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections. METHODS/DESIGN: HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 individuals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit. DISCUSSION: HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics. STUDY REGISTRATION: EU Health programmes project database https://webgate.ec.europa.eu/chafea_pdb/health/projects/900024/summary ; date of registration: 1 January 2021.

[Insight on how to assess and improve the response to the COVID-19 pandemic]. / Reflexiones sobre cómo evaluar y mejorar la respuesta a la pandemia de COVID-19.

The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise.

Arrangements with the NHS for providing healthcare services: do they improve financial performance of private for-profit hospitals in Spain?

BACKGROUND: In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS: With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS: Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS: Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.

Impact of sandstorm and carnival celebrations on SARS-CoV-2 spreading in Tenerife and Gran Canaria (Canary Islands, Spain).

OBJECTIVE: We address the hypothesis that the extraordinary sandstorm occurred on 22-24 February 2020 might have a role in the different cumulated incidence of COVID-19 cases between the islands of Tenerife and Gran Canaria, since it obliged to reduce significantly air traffic and forced to suspend all major carnival street events in all most locations. METHOD: We performed a retrospective analysis of COVID-19 cases as to 1 April 2020 according to symptoms onset, weather-related data and Carnival events in Tenerife and Gran Canaria. RESULTS: The sandstorm occurred on February 22-24, 2020, forced air traffic to close, reducing the influx of tourists to the Canary Islands and suspending carnival events in most places, except in Santa Cruz de Tenerife. Cumulated incidence as to 1 April was 132.81/100,000 in Tenerife, and 56.04/100,000 in Gran Canaria. CONCLUSIONS: The suspension of Carnival events due to the sandstorm in the Canary Islands contributed to reduce differently the SARS-CoV-2 spread in Tenerife and Gran Canaria.

The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.

Reducing antibiotic prescribing for lower respiratory tract infections 6 years after a multifaceted intervention.

AIMS: Few studies have evaluated the long-term impact of interventions on antibiotic prescription for lower respiratory tract infections (LRTI). This study was aimed at evaluating the use of antibiotics prescribed for LRTIs by general practitioners (GP) who underwent a multifaceted intervention carried out 6 years earlier. METHODS: General practitioners who had completed two registrations in 2008 and 2009 were again invited to participate in a third audit-based study in 2015. A multifaceted intervention was held 1-3 months before the second registration. A new group of GPs with no previous training on the rational use of antibiotics were also invited to participate and acted as controls. Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable. RESULTS: A total of 121 GPs of the 210 who underwent the intervention (57.6%) and 117 control GPs registered 4333 episodes of LRTIs. On adjustment for covariables, compared with the antibiotic prescription for LRTIs observed just after the intervention, antibiotic prescription slightly increased 6 years later among GPs who had undergone the intervention (OR 1.17, 95% CI 0.95-1.43), while control GPs prescribed significantly more antibiotics (OR 2.31, 95% CI 1.62-3.29). However, withholding antibiotic prescribing with C-reactive protein (CRP) values <10 mg/L was more frequently observed just after the intervention compared 6 years later (12.7% vs 32.2%; P < 0.01). CONCLUSIONS: Antibiotic prescribing for LRTIs remains low 6 years after an intervention, although GPs are less confident to withhold antibiotic therapy in patients with low CRP levels.

Economic crisis and obesity in the Canary Islands: an exploratory study through the relationship between body mass index and educational level.

BACKGROUND: The Canary Islands is one of the Spanish Regions with the highest obesity prevalence, and one of the Autonomous Communities that was hit hard by the economic crisis that arrived to Spain in 2008. This research studies the education-related inequalities in adult obesity in the Canary Islands and their evolution in recent years, considering the possible impact of the economic recession. METHODS: A repeated cross-sectional analysis is carried out with data obtained from the Canary Islands Health Surveys of 2004, 2009 and 2015. Obesity is measured through the body mass index (BMI). The analysis is performed using linear regression models for the general population and by gender, adjusting by age, educational attainment and island of residence. Likewise, the models also include dummy variables for each year and the corresponding interactions between the years and the education variable. RESULTS: The results show a decrease in the obesity prevalence in 2015 compared to 2009 (from 19.54 to 18.64%). An increase in the BMI of the population and that of women (+ 0.33 and + 0.59 units, respectively) in 2009, as well as a decline in the BMI of women with medium education (- 0.21 units) are also observed. Besides, there is an inverse correlation between education and BMI, and statistically significant differences among some islands. CONCLUSIONS: Obesity figures in the Canary Islands have decreased and women have been more greatly affected by the changes in BMI during the economic crisis. Due to the fact that educational attainment is a protective factor in general (and for women with medium education levels in times of crisis, in particular), regional authorities should implement actions that promote access to education and healthy lifestyles, paying attention to territorial disparities.

Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.

Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011-2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.

Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections.

Objectives: Few studies have evaluated the long-term effects of educational interventions on antibiotic prescription and the results are controversial. This study was aimed at assessing the effect of a multifaceted practice-based intervention carried out 6 years earlier on current antibiotic prescription for respiratory tract infections (RTIs). Methods: The 210 general practitioners (GPs) who completed the first two registrations in 2008 and 2009 were invited to participate in a third registration. The intervention held before the second registration consisted of discussion about the first registration of results, appropriate use of antibiotics for RTIs, patient brochures, a workshop and the provision of rapid tests. As in the previous registrations, GPs were instructed to complete a template for all the patients with RTIs during 15 working days in 2015. A new group of GPs from the same areas was also invited to participate and acted as controls. A multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: A total of 121 GPs included in the 2009 intervention (57.6%) and 117 control GPs registered 22 247 RTIs. On adjustment for covariables, compared with the antibiotic prescription observed just after the intervention, GPs assigned to intervention prescribed slightly more antibiotics 6 years later albeit without statistically significant differences (OR 1.08, 95% CI 0.89-1.31, P = 0.46), while GPs in the control group prescribed significantly more antibiotics (OR 2.74, 95% CI 2.09-3.59, P < 0.001). Conclusions: This study shows that a single multifaceted intervention continues to reduce antibiotic prescribing 6 years later.

Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome.

OBJECTIVES: Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia. METHODS: Population-based retrospective cohort of 10 563 patients discharged alive after an ACS in 2009-2011. We examined a control group (low-income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance and middle-income to high-income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period. RESULTS: Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACE inhibitor or an angiotensin II receptor blocker (ACEI/ARB) and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence, respectively, p<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary. CONCLUSIONS: Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost sharing.

[Impact of the Pharmaceutical Copayment Reform on the Use of Antidiabetics, Antithrombotics and for Chronic Obstructive Airway Disease Agents, Spain]. / Impacto de la reforma del copago farmaceútico sobre la utilización de medicamentos antidiabéticos, antitrombóticos y para la obstrucción crónica del flujo aéreo.

OBJECTIVE: In 2012 it changed the Spanish legislation regulating the pharmaceutical copayment by the National Health System (NHS). The objective was to know if the Spanish pharmaceutical copayment reform in 2012 has affected drugs consumptions for chronic diseases such as antidiabetics, antithrombotics and agents against obstructive conditions of the respiratory tract. METHODS: Retrospective longitudinal observational study, using general segmented linear regression models for interrupted time series. The variables analyzed were the number of defined daily doses (DDDs) and the amount corresponding to public funding and not public funding from the (NHS) since September 2010 to August 2015 (T=60). RESULTS: The estimated variation rate of DDDs is negative but decreasing for the three therapeutic subgroups at 6, 12, 24 and 38 months after the intervention: -0.1% for antidiabetics after 6 months and 0.3% after 38 months; -3.7% for antithrombotics after 6 months and -4.6% after 38 months; -2.7% for asthma and COPD drugs after 6 months and -1.3% after 38 months. A sustained and significant reduction in expenditure was estimated only in the subgroup of asthma and COPD drugs: -5.2% after 6 months, -7.0% after 12 months and after 24 months, and -6.2% after 38 months. CONCLUSIONS: The pharmaceutical copayment reform of 2012 led to an immediate and significant reduction in the number of DDDs of all three therapeutic subgroups selected in this study. This level effect is not permanent, as it is accompanied by a change in the growth trend in the post-intervention months, which has partly offset the effect on the level.

OBJETIVO: En 2012 cambió la legislación española que regulaba el copago farmaceútico de la prestación farmaceútica del Sistema Nacional de Salud (SNS).El objetivo fue conocer si la reforma del copago farmacéutico español en 2012 ha afectado al consumo de los medicamentos para enfermedades crónicas, tales como antidiabéticos, antitrombóticos y fármacos contra padecimientos obstructivos de las vías respiratorias. METODOS: Estudio observacional longitudinal retrospectivo. Se utilizaron modelos de regresión lineal segmentada general para series de tiempo interrumpido. Las variables analizadas fueron el número de dosis diarias definidas (DDDs) y el importe de la facturación de las dispensaciones financiadas y no financiadas por el SNS desde septiembre de 2010 hasta agosto de 2015 (T=60). RESULTADOS: La tasa de variación estimada de las DDDs fue negativa pero decreciente para los 3 subgrupos terapéuticos a los 6, 12, 24 y 38 meses de la intervención: -0,1% para antidiabéticos a los 6 meses y 0,3% a los 38 meses; -3,7% para antitrombóticos a los 6 meses y -4,6% a los 38 meses; -2,7% a los 6 meses para anti-asma y EPOC y -1,3% a los 38 meses. Se estimó una reducción mantenida y significativa del gasto únicamente en el subgrupo para asma y EPOC: -5,2% a los 6 meses, -7,0% a los 12 meses y a los 24 meses y -6,2% a los 38 meses. CONCLUSIONES: La reforma del copago farmacéutico de 2012 ocasiona una reducción inmediata y significativa en el número de dosis diarias definidas de los tres grupos terapéuticos estudiados. Este efecto nivel no es permanente ya que se acompaña de un cambio en la tendencia de crecimiento en los meses post-intervención que, en parte, compensa el efecto sobre el nivel.