Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement.

BACKGROUND: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. METHODS: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. RESULTS: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ±â€¯0.69 (mean ±â€¯standard deviation), 5.33 ±â€¯1.12 and 5.64 ±â€¯1.08, respectively. CONCLUSIONS: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.

Factores que influyen en la coordinación entre niveles asistenciales según la opinión de directivos y profesionales sanitarios / Factors influencing coordination among healthcare levels according to the opinion of healthcare managers and health professionals

ObjetivoAnalizar la coordinación entre niveles asistenciales desde la perspectiva de directivos y profesionales de organizaciones sanitarias integradas (OSI).MétodosEstudio cualitativo, descriptivo e interpretativo, mediante entrevistas individuales semiestructuradas, con muestreo teórico en dos etapas. En la primera se seleccionaron los contextos (las OSI) y en la segunda los informantes: directivos (n=18) y profesionales (n=23). Análisis de contenido, con generación mixta de categorías y segmentación por temas e informantes.ResultadosLa coordinación entre niveles es definida de diversas formas por los informantes, que coinciden en considerarla complicada, pero necesaria, para la mejora de la eficiencia. Comunicación, conocimiento y relación entre los profesionales emergen como factores determinantes centrales de la coordinación, sobre los que influyen los valores de los profesionales y la existencia de mecanismos apropiados en las instituciones. Ambos dependen de las condiciones estructurales y organizativas, principalmente de carácter interno, aunque también externas a las organizaciones, que determinan su desarrollo. Las estrategias de mejora propuestas se relacionan directamente con los factores identificados.ConclusionesLas opiniones sobre la coordinación asistencial reflejan la complejidad del término y la tradicional separación entre niveles asistenciales. Su mejora requiere acciones organizativas específicas que respondan a los determinantes, no sólo dentro de las organizaciones, sino también entre todos los proveedores de un territorio(AU)

ObjectiveTo analyze coordination among healthcare levels from the viewpoint of healthcare managers and health professionals in integrated healthcare systems (IHS).MethodsA qualitative, exploratory and descriptive study was conducted by means of individual semi-structured interviews to a criterion sample. We performed two-stage sampling: in the first stage, IHS were selected and in the second, managers (n=18) and professionals (n=23). A content analysis was carried out with mixed generation of categories, segmented by themes and informants.ResultsCoordination among healthcare levels was defined differently by the two groups of informants. However, the informants agreed that coordination was complicated but necessary to improve access to and the efficiency of the system. Factors central to achieving coordination were communication, knowledge and good relationships among professionals. These factors were influenced by professionals’ values and the existence of appropriate institutional coordination mechanisms. In turn, these elements depended mainly on internal but also external structural and organizational conditions, which determined the development of coordination. Improvement strategies were directly related to the factors identified.ConclusionsOpinions on healthcare coordination reflect not only the complexity of the concept, but also the traditional separation of healthcare levels. Improving coordination requires specific organizational interventions to address its determinants, not only within but also among all healthcare providers in an area(AU)

Nepal Medical Council: The past and the future.

The Nepal Medical Council (NMC) has been technically in operation for forty six years though in reality it is much less. The initial years were spent in establishing it. It is only in the last fifteen years or so that there has been much interest in it's functioning. The objective of the NMC is to protect the public and also to oversee the medical education being conducted within the country. A brief account of the NMC from its date of establishment till the present is given here.

Impacto de un sistema de compra capitativo en la coordinación asistencial / Impact of a capitation payment system on healthcare coordination

Objetivo: Evaluar desde una perspectiva cualitativa el impacto sobre la coordinación asistencial de la prueba piloto del sistema de compra capitativo en Cataluña.Métodos: Estudio cualitativo, exploratorio y descriptivo, mediante análisis de documentos y entrevista individual, con muestreo teórico de documentos e informantes: directivos del comprador(9), directivos de los proveedores (26), profesionales(16). Análisis de contenido, con generación mixta de categorías y segmentación por grupos de informantes, temas y áreas. El área de estudio la constituyeron las 5 zonas piloto.Resultados: La prueba facilitó, según los informantes, una visión conjunta del territorio y mejoró la comunicación. No obstante, los cambios introducidos a partir de la prueba para mejorar la coordinación asistencial fueron escasos. Se estableció una única alianza virtual entre proveedores de un territorio,con objetivos compartidos y cambios estructurales. En general, se intercambiaron los mecanismos de coordinación asistencial existentes, con un uso variable. La incertidumbre de la prueba, el temor a perder la identidad, el limitado interés ylos límites de gestión de algunos proveedores se percibían como barreras al cambio.Conclusiones: El sistema de compra capitativo, diseñado yejecutado, no generó incentivos suficientes para desencadenar cambios en la coordinación asistencial. Sería necesario corregir las debilidades identificadas en la evaluación antes de extender la prueba al resto de Cataluña

Objective: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective.Methods: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants’ groups, themes, and areas. The study area consisted of the 5 pilot zones.Results: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty,providers’ fears of losing their identity, lack of interest, and the management limits of some providers.Conclusions: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia

La coordinación sanitaria en España, ¿qué se puede hacer? / Health Care Coordination in Spain. What can be done?

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Barreras y facilitadores de la coordinación asistencial en dos organizaciones sanitarias integradas en Cataluña / Barriers and facilitators to health care coordination in two integrated health care organizations in Catalonia [Spain]

Objetivos: Analizar 2 organizaciones sanitarias integradas (OSI) en Cataluña e identificar las áreas de desarrollo futuro que mejoren su eficacia. Métodos: Investigación cualitativa, exploratoria y descriptiva, basada en un estudio de casos, mediante análisis de documentos y entrevista individual semiestructurada. Se seleccionó una muestra teórica de casos y, para cada caso, de documentos e informantes. Los casos de estudio fueron: el Consorci Sanitari del Maresme (CSdM) y el Consorci Sanitari de Terrassa/Fundació Hospital Sant Llàtzer (CSdT/FHSLL). Se analizaron 127 documentos y se entrevistaron 29 informantes: directivos de las OSI (n = 10), técnicos de apoyo (n = 5), directivos de las unidades operativas (n = 5) y profesionales asistenciales (n = 9). Se realizó un análisis de contenido, con generación mixta de categorías y segmentación por casos y temas. Resultados: El CSdM y el CSdT/FHSLL son organizaciones sanitarias con integración vertical hacia atrás, producción total de servicios, con propiedad real (CSdM) y virtual (CSdT/FHSLL). Reciben la financiación por nivel asistencial. El órgano de gobierno es centralizado en CSdM y descentralizado en CSdT/FHSLL. En ambas, los objetivos globales se orientan a la mejora de la coordinación y la eficiencia, pero sin alinearse con los de las unidades operativas. Su estructura es funcional, con integración de las funciones de apoyo, y utilizan mecanismos de coordinación entre niveles asistenciales basados en la normalización de los procesos de trabajo. Conclusiones: Se identifican los elementos facilitadores y también las barreras a la coordinación, que requieren cambios tanto del entorno (sistema de asignación) como internos (papel del gobierno, estructura organizativa y tipos de mecanismos de coordinación entre niveles)

Objectives: To analyze 2 integrated delivery systems (IDS) in Catalonia and identify areas for future development to improve their effectiveness. Methods: An exploratory, descriptive, qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews. A criterion sample of cases and, for each case, of documents and informants was selected. Study cases consisted of the Consorci Sanitari del Maresme (CSdM) and the Consorci Sanitari de Terrassa/Fundació Hospital Sant Llàtzer (FHSLL). A total of 127 documents were analyzed and 29 informants were interviewed: IDS managers (n = 10), technical staff (n = 5), operational unit managers (n = 5) and health professionals (n = 9). Content analysis was conducted, with mixed generation of categories and segmentation by cases and subjects. Results: CSdM and CSdT/FHSLL are health care organizations with backward vertical integration, total services production, and real (CSdM) and virtual (CSdT/FHSLL) ownership. Funds are allocated by care level. The governing body is centralized in CSdM and decentralized in CSdT/FHSLL. In both organizations, the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units. Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization. Conclusions: Both IDS present facilitators and barriers to health care coordination. To improve coordination, changes in external elements (payment mechanism) and in internal elements (governing body role, organizational structure and coordination mechanisms) are required

Gerencia única: una ilusión sin evidencia / Single management: an illusion without evidence

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Modernising the National Health and Medical Research Council.

The NHMRC is at a fork in the road - which route will the government take?

Educación sanitaria del paciente en atención primaria / Health education of patients in primary care

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Cidadania e participaçäo: os conselhos de saúde em Araçatuba, na década de 90 / Citizenship and participation: health councils in Araçatuba, in the 90`s

Tentar identificar as relaçöes entre as políticas públicas de saúde e as demandas da populaçäo e seu atendimento, intermediadas pelo papel representado pelo Conselho Municipal de Saúde (CMS) da cidade de Araçatuba, noroeste do Estado de Säo Paulo. Pretende analisar até que ponto esse Conselho se constituiu num canal de participaçäo da populaçäo, nos seus vários segmentos, na implementaçäo e na conduçäo das políticas de saúde do município. Procurou analisar, através de fontes documentais e entrevistas com os participantes do Conselho Municipal de Saúde, a real contribuiçäo dessa modalidade de gestäo plena para a conduçäo e soluçäo das questöes sanitárias da cidade, dando ênfase à participaçäo cidadä, no contexto atual da Reforma do Estado e do grave débito social existente no país.(AU)

Conclusiones primer encuentro nacional de municipios y comunidades saludables: "La promoción de la salud como fortalecimiento municipal" / Conclusions in the first national town halls and healthy communities workshop health promotion as city hall improvent

El presente documento nos da a conocer el Primer Encuentro Nacional de Municipios y Comunidades Saludables organizado por el Ministerio de Salud y Previsión Social y la Organización Panamericana de la Salud con 311 municipios del país, para convertirlos en los espacios para desarrollar acciones de promocion para la salud y que los gobiernos municipales formulen estrategias para acercar los servicios de salud a la población de su jurisdicción, coadyuvando de esta manera al fortalecimiento de la democracia y la instauración de un orden más justo, equitativo y solidario