Offerings and User Demands of eHealth Services in Spain: National Survey.

BACKGROUND: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users' demands; rather, supply seems to be governed by other variables. OBJECTIVE: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. METHODS: A survey, "Use and Attitudes Toward eHealth in Spain," was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95% and the margin of error was ±2.45 for the whole sample. RESULTS: The survey results showed that the online doctor's appointment service is the most frequently used eHealth service by users: 72.48% of respondents used this service at some point and 21.28% stated that they use it regularly. The other services showed significantly lower percentages of use, including "managing health cards" (28.04%), "consulting medical history" (20.37%), "managing test results" (20.22%), "communicating with health professionals" (17.80%), and "requesting a change of doctor" (13.76%). Despite this low usage, a large majority of respondents (80.00%) attach great importance to all the services offered. Overall, 16.52% of the users surveyed were willing to make new service requests to the regional websites, with 9.33% of them highlighting services such as "the availability of a complaints and claims mailbox," "the possibility of consulting medical records," and "the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc)." Other outstanding requests (8.00%) were to simplify the procedures for using certain existing services. CONCLUSIONS: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth. The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth.

The Present and Future of eHealth in Spain From a Health Management Perspective.

eHealth has grown significantly over the last decade. The aim of this study was to determine the level of use of information and communication technologies for health care in Spain and identify the main barriers to development. We used a qualitative study based on data obtained from 8 Spanish autonomous communities through semi-structured, in-depth interviews with key informants in eHealth management and planning. Programs present varying degrees of implementation. Services such as electronic prescriptions, digital medical records, and appointment requests via the Internet are advanced and widespread; others, such as digital imaging, are advanced but not fully deployed; and some, such as telecare programs, are experimental. The study also revealed diverse levels of interoperability and barriers to the expansion of these technologies, which can be classified into 4 fields: technological, organizational, human, and economic. eHealth might evolve more slowly in the coming years. Unless the payoff is clearly seen, major budget cuts in the current economic climate will prevent the implementation of new projects. Programs that help reduce health spending are more likely to be implemented, to the detriment of projects involving simple techniques or even clear health care improvements.

[Bringing in equity to health. An analysis of the autonomous communities health plans.] / Incorporando la equidad a la salud. Un análisis de los planes autonómicos sanitarios.

OBJECTIVE: The debate on equity in health, with long history and wide understanding, is more relevant today when considering the transcendence of this area. In the context of our system, it is appropriate to know the approach adopted by the autonomous communities. By analysing regional health plans in Spain it was intended to detect the perspectives applied in the search for equity, as well as to know the main goals of the plans and those groups or circumstances they try to deal with. METHODS: Based on the procedure of constant comparative analysis and content analysis, whose statistical treatment was conducted with Nvivo software (v12) and the analysis of Jaccard and Pearson correlation indexes, along with the triangulation of methods, data and researchers, the most recent regional health plans in progress (fourth quarter of 2019) were screened. RESULTS: Analized plans brought out that the search for equity is not given sufficient relevance. However, there are specific circumstances that standed out among the references to equity in the plans. Accessibility arised as a key category to understand the setup of health care as a public policy. CONCLUSIONS: The main paradigm found in regional health plans is that of equality or equity in access to health. To a lesser extent, it is also present a search for equal opportunities for various specific groups, such as people suffering from mental illness, people with functional diversity or who face some of the barriers or difficulties associated with the gender gap. Other items or groups considered by the regional administrations in a more reduced way, but also in a different manner, are immigration, rural habitat and infrastructures and elderly people.

OBJETIVO: El debate sobre la equidad en salud, con amplia trayectoria e interpretaciones, cobra más vigencia en la actualidad al considerar la trascendencia de esta área. En el contexto de nuestro sistema, resulta pertinente conocer la aproximación adoptada por las comunidades autónomas. Mediante el análisis de los planes de salud autonómicos se persiguió el objetivo de detectar las perspectivas que se habían aplicado a la búsqueda de la equidad en España, así como conocer sus principales metas y los colectivos o condiciones tomados en consideración. METODOS: Mediante el análisis comparativo constante y del análisis de contenido, cuyo tratamiento estadístico se realizó con el software Nvivo (v12) y el análisis de los índices de correlación de Jaccard y Pearson, junto con la triangulación de métodos, datos e investigadores, fueron examinados los planes generales de salud autonómicos más recientes a fecha del cuarto trimestre de 2019. RESULTADOS: Los planes analizados revelaron que no se otorga a la búsqueda de la equidad suficiente importancia, si bien se detectaron circunstancias específicas que destacan entre las referencias a la equidad recogidas por los planes. La accesibilidad emergió como categoría clave a la hora de entender la configuración de la sanidad como política pública. CONCLUSIONES: El principal paradigma presente en los planes de salud autonómicos es el de la igualdad o equidad en cuanto al acceso a la salud, seguido del de la búsqueda de igualdad de oportunidades para colectivos concretos, como son las personas que padecen enfermedades mentales, personas con diversidad funcional o que presentan alguna de las barreras o dificultades asociadas a la brecha de género. Otros ítems o colectivos contemplados en menor medida, pero de forma desigual entre las comunidades autónomas, son la inmigración, el hábitat rural e infraestructuras y el colectivo de personas mayores.

Opinión de los facultativos y usuarios sobre avances de la e-salud en atención primaria / Opinion of doctors and users on e-health advances in primary care

OBJETIVO: Explorar las opiniones de los usuarios y de los facultativos sobre el avance de la e-salud en atención primaria. DISEÑO: Grupos focales realizados entre el 1 de mayo y el 25 de septiembre de 2018. Emplazamiento: Nivel de atención primaria en los servicios autonómicos de salud. PARTICIPANTES: Un total de 29 usuarios y 33 facultativos vinculados a atención primaria contactados, respectivamente, a través de asociaciones de usuarios y por medio del servicio autonómico de salud. MÉTODO: Análisis inductivo de las transcripciones de grupos focales en torno a los siguientes temas: accesibilidad y seguridad; eficiencia; problemas de información y técnicos; potencialidades. RESULTADOS: Los servicios de salud en línea son positivamente valorados por usuarios y facultativos de atención primaria en términos de ahorro de costes. No obstante, la interacción presencial sigue considerándose clave en la calidad de servicio. Se comparte la preocupación por la seguridad de los datos y por las deficiencias formativas de usuarios y de facultativos en el acceso y la provisión de servicios de e-salud. El diseño adecuado de las aplicaciones constituye un condicionante para la aceptación y la difusión de las tecnologías que sostienen la salud en línea. CONCLUSIONES: La administración sanitaria debería intensificar la utilización de las nuevas tecnologías con un enfoque facilitador de la labor del facultativo, simplificando tareas burocráticas, aportando seguridad diagnóstica, prescriptiva y de protección de datos. Mientras los sistemas generen fallos y desconfianza continuarán percibiéndose como un complemento pero no como alternativa al modelo de atención tradicional

OBJECTIVE: To find out the opinions of users and primary care doctors on the progress of e-health in primary care. DESIGN: Focus groups set up between 1st May and 25th September 2018. LOCATION: Primary care level in regional online health services. PARTICIPANTS: A total of 29 users and 33 primary care doctors linked to primary care that were contacted, through user associations and regional public health services, respectively. METHOD: Inductive analysis of transcripts from focus groups about the following issues: accessibility and security; efficiency; information and technical problems; potentialities. RESULTS: Online health services are positively valued in terms of cost savings both by users and doctors of primary care. Nevertheless, face-to-face interaction is still considered a key factor in the quality of service. When it comes to the access and provision of e-health services, there is shared concern for the security of the data and for the training deficiencies of users and doctors. An adequate design of the applications becomes a condition for the acceptance and diffusion of technologies that support online health. CONCLUSIONS: Health authorities should intensify the use of new technologies oriented towards easing the work of doctors, simplifying bureaucratic tasks, providing diagnostic and prescription security, and protecting data. As long as systems generate failures and mistrust, new technologies will remain to be perceived as a complement, but not as an alternative to the traditional care model

Percepción del alumnado de medicina sobre la objeción de conciencia a la interrupción voluntaria del embarazo en Galicia / Perception of medical students in Galicia (Spain) regarding conscientious objection to the voluntary termination of pregnancy

OBJETIVO: Conocer si los futuros médicos y médicas de Galicia ejercerían la objeción de conciencia en la práctica de la interrupción voluntaria del embarazo (IVE), así como indagar sobre el conocimiento de que dispone actualmente el alumnado de medicina sobre la objeción de conciencia sanitaria y cuáles creen que son los costes que han de soportar las pacientes al no poder ejercer su derecho a la IVE dentro del servicio sanitario público. MÉTODO: Estudio transversal mediante una encuesta a 350 estudiantes de segundo y quinto curso del Grado de Medicina de la Universidad de Santiago de Compostela, en el curso académico 2017-2018. RESULTADOS: El 70,8% de las personas encuestadas no se declararía objetor/a de conciencia a la IVE. Además, el 70% estima que la objeción de conciencia a la IVE puede provocar consecuencias negativas para las gestantes cuando son derivadas desde la sanidad pública a la sanidad privada. No obstante, el 72,9% está a favor de que los médicos y las médicas tengan derecho a declararse objetores/as de conciencia a la práctica sanitaria de la IVE. CONCLUSIONES: La derivación de gestantes como consecuencia de la objeción de conciencia a la IVE es un importante problema en España en general y en Galicia en particular, frente al cual se observa que el futuro personal médico muestra una elevada predisposición a no objetar esta práctica sanitaria, lo que facilitaría su solución en un futuro próximo

OBJECTIVE: To discover whether future doctors in Galicia (Spain) are willing to express conscientious objection to voluntary termination of pregnancy (VTP). The medical students' level of knowledge regarding conscientious objection in health care was also examined, and their knowledge regarding the costs patients would incur if unable to exercise their right to VTP. METHOD: Cross-sectional study by conducting a survey of 350 medical students in the 2nd and the 5th years of the Degree in Medicine at the University of Santiago de Compostela, in the academic year 2017-2018. RESULTS: 70.8% of those surveyed would not declare conscientious objection to VTP. In addition, 70% believe that conscientious objection to VTP can have negative consequences for pregnant women if they are referred from public to private healthcare. However, 72.9% support physicians having the right to declare their conscientious objection to VTP. CONCLUSIONS: The problem of referring pregnant women to private healthcare, as a consequence of conscientious objection to VTP, is presented as critical in Spain, and in Galicia in particular. The future physicians showed that they strongly favoured not objecting to this healthcare practice, which will enable the problem to be resolved in the near future

[Perception of medical students in Galicia (Spain) regarding conscientious objection to the voluntary termination of pregnancy]. / Percepción del alumnado de medicina sobre la objeción de conciencia a la interrupción voluntaria del embarazo en Galicia.

OBJECTIVE: To discover whether future doctors in Galicia (Spain) are willing to express conscientious objection to voluntary termination of pregnancy (VTP). The medical students' level of knowledge regarding conscientious objection in health care was also examined, and their knowledge regarding the costs patients would incur if unable to exercise their right to VTP. METHOD: Cross-sectional study by conducting a survey of 350 medical students in the 2nd and the 5th years of the Degree in Medicine at the University of Santiago de Compostela, in the academic year 2017-2018. RESULTS: 70.8% of those surveyed would not declare conscientious objection to VTP. In addition, 70% believe that conscientious objection to VTP can have negative consequences for pregnant women if they are referred from public to private healthcare. However, 72.9% support physicians having the right to declare their conscientious objection to VTP. CONCLUSIONS: The problem of referring pregnant women to private healthcare, as a consequence of conscientious objection to VTP, is presented as critical in Spain, and in Galicia in particular. The future physicians showed that they strongly favoured not objecting to this healthcare practice, which will enable the problem to be resolved in the near future.

[Opinion of doctors and users on e-health advances in primary care]. / Opinión de los facultativos y usuarios sobre avances de la e-salud en atención primaria.

OBJECTIVE: To find out the opinions of users and primary care doctors on the progress of e-health in primary care. DESIGN: Focus groups set up between 1st May and 25th September 2018. LOCATION: Primary care level in regional online health services. PARTICIPANTS: A total of 29 users and 33 primary care doctors linked to primary care that were contacted, through user associations and regional public health services, respectively. METHOD: Inductive analysis of transcripts from focus groups about the following issues: accessibility and security; efficiency; information and technical problems; potentialities. RESULTS: Online health services are positively valued in terms of cost savings both by users and doctors of primary care. Nevertheless, face-to-face interaction is still considered a key factor in the quality of service. When it comes to the access and provision of e-health services, there is shared concern for the security of the data and for the training deficiencies of users and doctors. An adequate design of the applications becomes a condition for the acceptance and diffusion of technologies that support online health. CONCLUSIONS: Health authorities should intensify the use of new technologies oriented towards easing the work of doctors, simplifying bureaucratic tasks, providing diagnostic and prescription security, and protecting data. As long as systems generate failures and mistrust, new technologies will remain to be perceived as a complement, but not as an alternative to the traditional care model.