Building a network of TP53 and IGHV testing reference centers across Spain: the Red53 initiative.

Among the different biomarkers predicting response in chronic lymphocytic leukemia (CLL), the most influential parameters are the mutational status of the IGHV genes and the presence of TP53 gene disruptions. Nevertheless, these important assessments are not readily available in most centers dealing with CLL patients. To provide this molecular testing across the country, the Spanish Cooperative Group on CLL (GELLC) established a network of four analytical reference centers. A total of 2153 samples from 256 centers were analyzed over a period of 30 months. In 9% of the patients, we found pathological mutations in the TP53 gene, whereas 48.96% were classified as IGHV unmutated. Results of the satisfaction survey of the program showed a Net Promoter Score of 85.15. Building a national network for molecular testing in CLL allowed the CLL population a broad access to complex biomarkers analysis that should translate into a more accurate and informed therapeutic decision-making.

O futuro do sistema de saúde na Espanha: será possível financiá-lo sem reformas estruturais? / The future of the health system in Spain: will it be possible to finance it without structural reforms? / El futuro del sistema sanitario en españa: será posible financiarlo sin reformas estructurales?

Os sistemas de saúde contribuíram claramente para melhorar o estado de saúde da população, mas a taxa de crescimento dos gastos em saúde, superior à do crescimento do PIB nos países desenvolvidos, levanta questões sobre sua sustentabilidade. No entanto, a análise da sustentabilidade tende a ser parcial: concentra-se nos gastos com a saúde e, raramente, na cobertura e nas receitas fiscais do sistema de saúde, um ponto crítico no caso da Espanha. Neste artigo analisamos o impacto da crise econômica na sustentabilidade do sistema de saúde espanhol, e não apenas seu impacto econômico, mas também em termos de aumento de saúde e desigualdades. E, finalmente, uma estimativa do crescimento dos gastos de saúde pública em Espanha para os próximos anos em um cenário de reforma e um cenário de crescimento sem mudanças estruturais, para trazer para fora o custo de não fazer nada é feito. Mudanças e reformas tornam-se imperativas, mas isso requer um clima de discussão calma e aberta que envolva todos os atores do processo, abordando os problemas reais. (AU)

Health systems have clearly contributed to improving the health status of the population, but the growth rate in health spending, higher than that of GDP growth in developed countries, raises questions about its sustainability. However, the analysis of sustainability tends to be partial: it focuses on health spending, and rarely on the coverage and tax revenues of the health system, a critical point in the case of Spain. In this article we analyze the impact of the economic crisis on the sustainability of the Spanish health system, and not only its economic impact, but also in terms of increasing health and inequalities. And finally, an estimate is made of the growth of public health expenditure in Spain for the next few years, in a scenario of reforms and in a growth scenario without structural changes, to highlight the cost of doing nothing. Changes and reforms become imperative, but this requires a climate of calm and open discussion that involves all the actors in the process, addrerrssing the real problems. (AU)

Los sistemas sanitarios han contribuido de forma clara a la mejora del estado de salud de la población, pero el ritmo de crecimiento del gasto sanitario, superior al del crecimiento del PIB en los países desarrollados, presenta dudas sobre su sostenibilidad. Sin embargo, el análisis de la sostenibilidad tiende a ser parcial: se focaliza sobre el gasto sanitario, y pocas veces sobre las coberturas y los ingresos fiscales del sistema sanitario, punto crítico en el caso de España. En este artículo se analizan el impacto de la crisis económica en la sostenibilidad el sistema sanitario español, y no solo su impacto económico, sino en términos de salud y desigualdades crecientes. Y finalmente se hace una estimación del crecimiento del gasto sanitario público en España para los próximos años, en un escenario de reformas y en un escenario de crecimiento sin cambios estructurales, para poner en evidencia el coste de no hacer nada. Los cambios y reformas se hacen imperativos, pero esto requiere un clima de discusión sosegado y abierto que involucre a todos los actores del proceso, abordando los problemas reales. (AU)

Priorización de medidas para la consolidación de la toma de decisiones compartidas en las prestaciones del Sistema Nacional de Salud español / Prioritising measures for consolidating shared decision-making in the services rendered by the Spanish National Health System

Objetivo: Identificar y priorizar, por su relevancia, medidas, intervenciones e instrumentos indispensables para respaldar el establecimiento de un marco estratégico en el Sistema Nacional de Salud de España, y garantizar el ejercicio corresponsable e informado de la autonomía de sus usuarios y pacientes en la toma de decisiones compartidas. Método: Consulta grupal, estructurada de acuerdo con procedimientos adaptados de las técnicas de «tormenta de ideas», grupo nominal y método de consenso Rand. Resultados: Las 10 personas consultadas propusieron 53 posibles actuaciones centradas en medidas estructurales «macro» (soporte jurídico garantista, priorización explícita de la toma de decisiones compartidas, medidas curriculares del sistema docente y dinamización del cambio cultural), «meso» (generación y difusión de información acreditada por líneas de investigación específicas e instrumentos de ayuda a la toma de decisiones compartidas) y «micro» (estímulo a la inserción de la toma de decisiones compartidas en la relación de agencia con la ciudadanía y usuarios del sistema sanitario). Conclusiones: El consenso emergente de la consulta apunta a la necesidad de incorporar, a las prioridades estratégicas de la política sanitaria, medidas estructurales que avalen y dinamicen el desarrollo de la toma de decisiones compartidas en una serie de áreas específicas de evolución y cambio en la relación entre profesionales de la salud y pacientes como atributo de calidad en el acceso a las prestaciones y los servicios del sistema público de salud

Objective: Identify and prioritize according to their relevance, measures, interventions and indispensable instruments to support the establishment of a strategic framework in the Spanish National Health System to enable the responsible and informed exercise of the autonomy of its users and patients for shared decision-making. Method: Group consultation, structured according to procedures adapted from brainstorming techniques, nominal group and Rand consensus method. Results: The 10 panellists proposed 53 possible actions focusing on "macro" structural measures (legal support and explicit prioritization of shared decision-making on health policy, curricular measures of the teaching system and dynamisation of cultural change), "meso" (generation and dissemination of accredited information by specific research lines and instruments to help shared decision-making), and "micro" activities (measures to stimulate the introduction of shared decision-making in the agency relationship with citizen and users of the healthcare system). Conclusions: The consensus emerging from the consultation points to the need to incorporate into the strategic priorities of health policy, structural measures that support and encourage the development of shared decision-making in a number of specific areas of evolution and change in the relationship between health professionals and patients as an attribute of quality in access to the benefits and services of the public healthcare system

[Prioritising measures for consolidating shared decision-making in the services rendered by the Spanish National Health System]. / Priorización de medidas para la consolidación de la toma de decisiones compartidas en las prestaciones del Sistema Nacional de Salud español.

OBJECTIVE: Identify and prioritize according to their relevance, measures, interventions and indispensable instruments to support the establishment of a strategic framework in the Spanish National Health System to enable the responsible and informed exercise of the autonomy of its users and patients for shared decision-making. METHOD: Group consultation, structured according to procedures adapted from brainstorming techniques, nominal group and Rand consensus method. RESULTS: The 10 panellists proposed 53 possible actions focusing on "macro" structural measures (legal support and explicit prioritization of shared decision-making on health policy, curricular measures of the teaching system and dynamisation of cultural change), "meso" (generation and dissemination of accredited information by specific research lines and instruments to help shared decision-making), and "micro" activities (measures to stimulate the introduction of shared decision-making in the agency relationship with citizen and users of the healthcare system). CONCLUSIONS: The consensus emerging from the consultation points to the need to incorporate into the strategic priorities of health policy, structural measures that support and encourage the development of shared decision-making in a number of specific areas of evolution and change in the relationship between health professionals and patients as an attribute of quality in access to the benefits and services of the public healthcare system.

La planificación estratégica en las organizaciones sanitarias / Strategic planning in healthcare organizations

La planificación estratégica es una herramienta con plena vigencia y utilidad en la dirección de todo tipo de organizaciones, incluidas las organizaciones sanitarias. El nivel de la organización al que el proceso de planificación estratégica es pertinente es función del tamaño de la unidad, de su complejidad y de la diferenciación del servicio que se presta. Un servicio de cardiología o una unidad de electrofisiología o de hemodinámica pueden ser un nivel adecuado siempre que su plan se alinee con otros eventualmente existente en niveles superiores. Es el líder de cada unidad el responsable de promover el proceso de planificación, como parte esencial y nuclear de su función. El proceso para la planificación estratégica es programable, sistemático, racional y holístico e integra el largo, medio y corto plazo, lo que permite orientar la organización sanitaria hacia transformaciones relevantes y duraderas para el futuro (AU)

Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity and the differentiation of the service provided. A cardiology department, a hemodynamic unit or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future (AU)

Nuevo contexto y viejos retos en el sistema sanitario / New context and old challenges in the healthcare system

La crisis económica no puede ocultar la necesidad de transformación del Sistema Nacional de Salud. Desde hace años son bien conocidas las dificultades financieras del sistema sanitario, cuyo gasto crece a un ritmo superior que la economía. El desarrollo y la difusión de las nuevas tecnologías y la mayor utilización de los servicios de salud, junto con el gasto farmacéutico, la inflación de los precios y la poca eficiencia del sistema, explican el nuevo contexto. Los retos que afronta el sistema de salud no son nuevos: abordar la deuda, mejorar la financiación, revisar el catálogo de prestaciones, transformar la gobernanza del sistema y dotar a las instituciones de una real autonomía de gestión. La gravedad de la situación económica puede ser una oportunidad para efectuar los cambios largamente esperados (AU)

The economic crisis cannot conceal the need for transformation of the National Health System. The financial difficulties of healthcare systems whose spending is growing at a faster rate than the economy have been well known for years. The development and diffusion of new technologies, increased use of health services, rising drug costs, inflation of prices, and the inefficiency of the system explain the new context. The challenges facing the healthcare system are not new: address the debt, improve funding, review the list of services, transform the governance of the system and provide the institutions with real management autonomy. The gravity of the economic situation can be an opportunity to carry out the long-awaited changes (AU)

Strategic planning in healthcare organizations.

Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity, and the differentiation of the service provided. A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium, and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future.

New context and old challenges in the healthcare system.

The economic crisis cannot conceal the need for transformation of the National Health System. The financial difficulties of healthcare systems whose spending is growing at a faster rate than the economy have been well known for years. The development and diffusion of new technologies, increased use of health services, rising drug costs, inflation of prices, and the inefficiency of the system explain the new context. The challenges facing the healthcare system are not new: address the debt, improve funding, review the list of services, transform the governance of the system and provide the institutions with real management autonomy. The gravity of the economic situation can be an opportunity to carry out the long-awaited changes.

Coste y valor de la radioterapia / Cost and value of radiation therapy

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Integración de proveedores de servicios asistenciales

No disponible