[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.

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

Objetivo: En el mes de septiembre de 2022, la Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS) reunió un panel de personas expertas con el objetivo de definir y priorizar las políticas de salud, desde una perspectiva del conjunto del Estado, para adaptar el Sistema Nacional de Salud (SNS) a los actuales riesgos y la actual sociedad. Método: Reunión de personas expertas, estructurada siguiendo procedimientos adaptados de las técnicas de brainstorming, grupo nominal y método de consenso Rand. La relevancia y la factibilidad de las propuestas fueron valoradas individualmente por cada panelista, y se ordenaron temáticamente y en función de la mediana y la desviación cuartil de las puntuaciones de relevancia. Resultados: Los/las panelistas identificaron y priorizaron numerosas propuestas en áreas de gobernanza y financiación del SNS, reforma de la cartera de servicios y prestaciones, reforma de los recursos humanos del SNS, salud pública y políticas de salud, actuaciones frente a las desigualdades y la pobreza, y asistencia sanitaria del SNS, incluyendo la atención sociosanitaria, primaria y al final de la vida. Conclusiones: Los resultados del Encuentro muestran la urgente necesidad de abordar cambios en profundidad en muchas de las políticas de salud estatales, incluyendo una importante reconfiguración en sus estructuras de gobernanza, salud pública y atención sanitaria. También sugieren hacia dónde podrían orientarse tales cambios, conformando una guía tentativa de temas prioritarios a abordar. (AU)

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. (AU)

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

Objetivo: En el mes de septiembre de 2022, la Sociedad Espa ˜nola de Salud Pública y AdministraciónSanitaria (SESPAS) reunió un panel de personas expertas con el objetivo de definir y priorizar las políticasde salud, desde una perspectiva del conjunto del Estado, para adaptar el Sistema Nacional de Salud (SNS)a los actuales riesgos y la actual sociedad.Método: Reunión de personas expertas, estructurada siguiendo procedimientos adaptados de las técni-cas de brainstorming, grupo nominal y método de consenso Rand. La relevancia y la factibilidad de laspropuestas fueron valoradas individualmente por cada panelista, y se ordenaron temáticamente y enfunción de la mediana y la desviación cuartil de las puntuaciones de relevancia.Resultados: Los/las panelistas identificaron y priorizaron numerosas propuestas en áreas de gobernanzay financiación del SNS, reforma de la cartera de servicios y prestaciones, reforma de los recursos humanosdel SNS, salud pública y políticas de salud, actuaciones frente a las desigualdades y la pobreza, y asistenciasanitaria del SNS, incluyendo la atención sociosanitaria, primaria y al final de la vida.Conclusiones: Los resultados del Encuentro muestran la urgente necesidad de abordar cambios en pro-fundidad en muchas de las políticas de salud estatales, incluyendo una importante reconfiguración ensus estructuras de gobernanza, salud pública y atención sanitaria. También sugieren hacia dónde podríanorientarse tales cambios, conformando una guía tentativa de temas prioritarios a abordar.(AU)

Objective: In September 2022, the Sociedad Espa ˜nola de Salud Pública y Administración Sanitaria (SESPAS)brought together a panel of experts with the aim of defining and prioritizing health policy proposals, fromthe perspective of the Spanish State as a whole, to adapt the National Health System (NHS) to currentrisks and to contemporary/present-day society.Method: Expert meeting structured using a mix of procedures adapted from brainstorming, nominalgroup and Rand consensus method techniques. Relevance and feasibility of proposals identified wereassessed individually by each panelist. Proposals were then ordered thematically and ranked accordingto the median and quartile deviation of relevance scores.Results: Panelists identified and prioritized several proposals in different areas: governance and fundingof the NHS, reform of the portfolio of services and benefits and of the NHS human resources, publichealth and health policy, actions against inequality and poverty, and healthcare delivery reform, includingsocio-sanitary, primary and end-of-life care.Conclusions: The results of the meeting show the urgent need to address in-depth changes in manystate-wide health policies, including a major reconfiguration of governance, public health, and healthcare structures. They also point out potential areas of improvement, constituting a tentative guide ofprioritized issues to be addressed.(AU)

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.

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.

La medicalización de la vida y la reciente emergencia de la "medicamentalización" / Life medicalization and the recent appearance of "pharmaceuticalization"

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

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

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.

Documento del grupo de trabajo SESPAS-OMC sobre iatrogenia / No disponible

No disponible

Las llaves del acceso abierto / The keys to open access

No disponible

[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.

Barreras a la introducción de una agencia evaluadora para informar la financiación o la desinversión de prestaciones sanitarias del Sistema Nacional de Salud / Barriers for Introducing a Health Technology Assessment Organization to Inform Health Care Decision-Making in the Spanish National Health System

Fundamentos: A diferencia de lo que ocurre en otros países, el Sistema Nacional de Salud (SNS) español no ha incorporado el análisis coste-efectividad en la toma de decisiones de las tecnologías y prestaciones que integran cartera de servicios, ni ha desarrollado los organismos de evaluación capaces de desarrollar esta función. El objetivo de este trabajo es identificar las dificultades, obstáculos y limitaciones que han contribuido a estas carencias. Métodos: Reunión de 14 expertos, en julio de 2012, estructurada siguiendo procedimientos adaptados de las técnicas de tormenta de ideas, grupo nominal y método de consenso Rand. Resultados: El panel propuso 77 ítems como posibles dificultades, obstáculos o limitaciones para el establecimiento de un "ente" oficial e independiente con capacidad para informar sobre la financiación y desinversión selectiva de las prestaciones del SNS. Estos ítems se centraron en: 1) ausencia de voluntad política de los gobiernos estatal y autonómicos para introducir el análisis coste-efectividad y la falta de independencia y transparencia de los procesos de evaluación, 2) la tensión entre un sistema sanitario descentralizado y la actividad evaluadora que tiene importantes economías de escala,3) dificultades técnicas de los procesos evaluadores y de su capacidad para influir en la toma de decisiones, y 4) rechazo social y profesional a la exclusión de prestaciones cuando es percibida como indiscriminada. Conclusiones: Aunque existe un variado número y tipo de obstáculos en el desarrollo de la capacidad del SNS para incorporar o excluir prestaciones en función de la evaluación de su efectividad y eficiencia, los expertos sitúan en el plano más político del sistema sanitario las principales dificultades para avanzar en este terreno (voluntad política, transparencia, gobernanza) (AU)

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 is investment. 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 an devaluation 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 health care 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 an defficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field (AU)

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

En 2010, el Sistema Nacional de Salud (SNS) facturó 958 millones de recetas. Dada la masiva exposición de la población a los medicamentos, los riesgos asociados a su consumo adquieren una enorme relevancia desde la perspectiva de salud pública. Pacientes sobremedicados en situaciones de bajo riesgo e inframedicados en situaciones de indicación demostrada, deficientemente informados, polimedicados, automedicados y un porcentaje no despreciable que sufre efectos adversos evitables, es en buena parte la fotografía de la prescripción en atención primaria que puede mejorarse. Sorprendentemente, la mayor parte de las estrategias farmacéuticas en el SNS no se han orientado al control de estos problemas, sino sobre todo a reducir el gasto farmacéutico, que no es el problema sino una de las consecuencias de «los problemas» de la prescripción (y de la regulación y la gestión de la prestación farmacéutica). Algunos elementos esenciales para mejorar esta situación pasan por una mayor integración asistencial, el desarrollo de la historia clínica electrónica, estrategias globales de mejora de la seguridad y la reducción del papel de la industria farmacéutica, hasta estrategias más macro, como la creación de una agencia que pueda evaluar objetivamente el valor adicional aportado por un nuevo medicamento y su coste adicional, la fijación de precios acorde con la relación coste-efectividad, la exclusión de la cobertura de medicamentos con escaso o nulo valor añadido, etc. Gestionar la prescripción implica el desarrollo de programas longitudinales de atención a los pacientes que incorporen las actuaciones clínicas de los diferentes profesionales, incluyendo a quién, cuánto y con qué tratar (AU)

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 (AU)

[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.

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

Los países prosperan sobre una base económica que permita desarrollar las potencialidades humanasen una sociedad que no renuncie a grandes logros, como el del estado del bienestar. Ello requiere quesus "reglas de juego", sus instituciones formales e informales, hagan individualmente atractivo lo socialmenteconveniente. Mejorar el gobierno sanitario, también en su faceta de control de la corrupción, ycontribuir a que Espa˜na salga de la actual crisis económica, constituyen dos caras de la misma moneda.La caracterización del gobierno sanitario en Espa˜na y el análisis de su impacto en las políticas de salud, lagestión de las organizaciones sanitarias y la práctica clínica, –permite elaborar una agenda tan ambiciosacomo factible de las tareas pendientes que los profesionales sanitarios -en sentido muy amplio- y losresponsables sociales debemos acometer con el apoyo ciudadano (AU)

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

[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.